Understanding an eczema outbreak is really complex. And like a child learning language, you have to understand the alphabet and sounds first before you can talk. Same goes for eczema.

To really understand an eczema outbreak, you have to first understand the difference between the way functional medicine and conventional medicine views it.

Why Functional Medicine?

Functional medicine (FM) is a “systems” way of thinking. And when we say “systems,” it’s not like conventional medicine that views the body as a group of isolated systems where you have a cardiologist for the heart, an endocrinologist for hormones, etc. In FM, we view the systems, or areas of the body, as operating as a whole response to the environment (kind of like the operating system of a computer).

It makes perfect sense because each area influences the others.

A good analogy to help you understand functional medicine versus conventional medicine is to think about a tree. Visualize the entire tree with its roots, trunk, branches, and leaves. Conventional medicine looks at one branch, whereas functional medicine views all of the branches, trunk, and roots. It’s going to look at the leaves and even further in-depth because we really want to understand what’s going on in the entire person.

When we do this, we take a really detailed history and look for root causes. It’s interesting that we look for root causes and use the tree analogy, because the goal is to find out what is foundationally disrupted in your body to figure out what’s causing the eczema flare.

Conventional medicine really tends to see eczema as something that doesn’t truly have a cause yet. When I was told that I had eczema the doctor said, “You’ve got eczema. There’s no known cure. See you later.” However, in functional medicine—and now even in the medical literature (check it out here)—they’re starting to talk about it as an autoimmune condition and starting to identify some causes of it. And that’s what we’re going to get into here a little bit later.

This is why taking a FM approach to looking at eczema really can help you get down to why things are happening.

The ATM Model

One of the foundational principles of understanding functional medicine is the concept of antecedents, triggers and mediators. We call it the ATM model. These are how a functional medicine practitioner frames an understanding of your entire life history and contributing factors to your condition. We’re looking at all of that to figure out how you got to where you are today.

Let’s start off with the antecedents, which are the predisposing factors. Those are things like genetics and family history, lifestyle, past illness, and exposures (occupational, home, or environmental), and are the underlying or precipitating cause of illness.

A key point regarding genetics and family history is that they aren’t life sentences. A lot of people think, “Oh, there’s cancer in my family. I’m going to get cancer.” That’s not necessarily the case. There are so many modifiable factors here that can prevent you from actually having that illness even though you might be very prone to having it. Great news!!

To recap: Genetics are largely modifiable. NOT your destiny. **Note, in a future post I’ll address genetic concerns such as the filaggrin protein and common SNPs (single nucleotide polymorphisms) that matter to eczema suffers.

Triggers are what provoke the signs and symptoms of illness. Those are along the lines of infections, allergens, toxins, radiation, surgery, social conditions, and things of that nature. They’re going to combine with the antecedents to actually cause more signs and symptoms.

Last, the mediators perpetuate the illness. You can think about these on a biochemical or psychosocial level. Biochemically speaking, the hormones, neurotransmitters, metabolites, free radicals, and inflammatory chemicals are what perpetuate what’s going on. Once you have that genetic factors, plus the triggers, these mediators keep that cycle going. In the case of eczema, it’s going to cause the flare to continue.

The psychosocial factors—stress, thoughts, beliefs, community- are extraordinarily important in this model, but also in eczema. Stress is often the primary trigger and tipping point for most people (***remember stress can be emotional or physiological like trauma or infection…regardless of the source, it causes systemic biochemical changes that are bad if they continue for a prolonged period of time).

Eczema ATM’s

Genetics, family history, lifestyle, past illness, and environmental exposures are key antecedents for everyone. For example, if you have certain historical factors like a family history of autoimmunity or allergies, asthma, and eczema (the allergic triad) you’re much more likely to get eczema than the rest of the population.

The most common triggers I see in practice are infections, allergens, toxins, diet, and dysbiosis (an imbalance in the microorganisms in your body—not just in your gut, but all over your body). In eczema, skin dysbiosis can be an important piece of the puzzle too.

Depleted Nutrients. In practice it’s usually omega 3 fatty acids, vitamin D, antioxidants such as vitamin C and selenium, and minerals such as zinc and magnesium. Protein malabsorption can be an issue too since you need the amino acids to make collagen and skin tissue.

Inflammatory chemicals. Histamine, cytokines, and free radicals are major contributors here, though there’s a long list of players in this biochemical pool.

Impaired liver function. If you’re liver can’t function optimally, you can’t clear metabolic waste, toxins or hormones efficiently which are essential for a healthy gut and skin. This is often one of the key places we address first.

Leaky gut. This occurs when many of the above factors cause increased intestinal permeability allowing things into the bloodstream (like bacteria, toxins, proteins, etc.) that shouldn’t be there. This causes inflammation and immune system activation driving the eczema cycle.

I find for most of the clients we see in our virtual clinic is that stress is often the most significant factor, either as a trigger or as something that’s perpetuating, or both. We work on addressing it in its many forms, in many different ways.

To recap- if you’re having an eczema flare or a flare-up of any autoimmune condition- you’re looking at: antecedents + the triggers + the mediators= cause of flare.

It’s a cyclical process that self-perpetuates until you identify the triggers and the root causes to stop this cycle. You must eliminate the root cause imbalances such as infections, hormone and nutrient imbalances, allergens, foods, etc., to get this cycle to stop. Then you actually need to take the proper steps to heal it (replacing nutrients, healing leaky gut, balancing hormones, improving liver function, etc.).

Real Life Eczema Example

I’m going to use myself as an example. I’m not necessarily proud of this, but we’re all human 😉

I was driving home from my sister’s this past Halloween. I had just thought to myself that I was so excited because I didn’t have any Halloween candy…. but then I did.

BAD IDEA!

About an hour later, it triggered a flare. And for me, the area where my eczema always, always, always starts is my left wrist and my left hand. They started itching like mad. I was scratching for four hours.

UGH!!!

Immediately, I went downstairs and took some anti-inflammatory nutrients because I knew I had to get at that flare before it became a full-blown outbreak. Yes, it is possible to dampen the effect of a flare once you have your eczema under control.

But for me, I had a major flare. My last major flare was 1.5- 2 years ago. I hadn’t had anything go on since then until I was pregnant recently and had a few minor flares (due to hormones) that went away quickly.

Let’s also review my ATM’s.

My major antecedent is the allergic triad in myself and family members. As I mentioned above, the allergic triad is allergies, asthma and eczema. Most of that manifests in childhood, but not always. I only had allergies in childhood. Eczema started in my 30’s! If you have any of those, you’re also going to be more prone to autoimmunity as an adult.

And, eczema often accompanies other autoimmune conditions, not just in and of itself.

So I have 2 of the allergic triad, and a family history of autoimmunity and inflammation conditions. There’s lots of cardiovascular disease and diabetes in my family. Historically, I was bottle fed and was around smokers growing up which are also key antecedents in developing eczema.

My main trigger for this flare was hormone imbalance and dysbiosis that developed during pregnancy. In the gut, when your hormones such as progesterone are high, it slows things down in pregnancy. It sets the stage for things like leaky gut and dysbiosis to occur. This was something that I had experienced quite a bit of during my pregnancy (even though I tried my hardest to prevent it since I know what I know!!).

Diet was also a key trigger (especially the candy). I kept a clean, organic diet for the most part. However, after the birth, my diet has not been quite as tight. I’m gluten-free and try to be in the realm of Paleo/Autoimmune Paleo. But sometimes I have corn or dairy or beans. And those things have crept into my diet more frequently now that I’ve had the baby.

The candy just happened to be the breaking point for me… that little bit put me over the edge!

My primary mediators were hormone and nutrient imbalances from pregnancy and breastfeeding, leaky gut, and STRESS.

I’m going to reiterate stress here… I’ve got a new baby. I’ve got a 5 year old. I’ve got work. I’ve got life. Everybody’s got stress. But I currently feel like I have a lot on my plate. That’s the main mediator perpetuating the cycle for me.

And for me, stress is probably the number one factor that contributes to my flares every single time. When my stress levels get high, I can get a flare super easily. And I know that’s true for many of the people we work with in the clinic as well.

Another less obvious mediator is lack of sleep. Lack of sleep is a major contributor to manifesting any autoimmune condition, especially something like eczema. We heal and regenerate when we sleep. If you’re not sleeping well, it’s not happening.

Lastly, there’s the issue of support and community, or a lack thereof. When you first have a baby, everyone comes and sees you for the first couple of weeks. And then it’s suddenly, it’s gone. This can leave you with a sense of feeling like you’re lacking community or lacking support. I won’t say that I feel that tremendously, but I feel it a little bit.

All of these things added up and resulted in my eczema flare.

I got it under control by tightening up my diet, doing some keysupplementation, andtopical salves. Thankfully, this prevented it from erupting into a full-blown outbreak.

Leaky gut, as you might be imagining it in your head, is layman terminology for intestines that have increased permeability.

This can be due to a variety of reasons, which we’ll dive into shortly, but first let’s provide a basic understanding of how the GI tract works.

The gut is a tube that is about 20-25 feet long, covers 3000 square feet (the size of a tennis court) of surface area and is only one cell layer thick, according to Dr. Mark Hyman.7

There are spaces between this single layer of intestinal cells that open and close to allow only specific, very small molecules to pass. These spaces are controlled by tight junctions.

What Exactly is Leaky Gut or Intestinal Hyper-Permeability?

The primary purpose of the GI tract is to provide barrier function, as well as to allow the selective passage of substances it deems beneficial, all the while keeping foreign invaders out.

Every second of every day, your intestinal cells, along with the immune, neurological and hormonal components within them, screen your environment in an effort to keep you healthy.

Leaky gut occurs when there is a breakdown in this barrier function allowing substances to enter the bloodstream that normally wouldn’t be there, resulting in immune system activation and inflammation.

Dr. Alessio Fasano lays it out nicely, saying that “The intestinal mucosa is the battlefield on which friends and foes need to be recognized and properly managed to find the balance between TOLERANCE and the immune response.”2,3,4

How Does Leaky Gut Occur?

The tight junctions in a healthy gut operate like a club bouncer, selecting what to allow past the “velvet rope” and into the bloodstream. Simply put, they keep bad things out and allow good things through.

In a Leaky Gut however, the tight junctions leave the “velvet rope” unattended, allowing everything to pass through. This can result in serious problems.

Technically speaking, Leaky Gut, also commonly referred to as intestinal hyper-permeability, occurs when inflammation leads to the breakdown of the mechanism that controls the tight junctions between the intestinal cells, allowing them to become looser. This allows the “leaking” of either larger and/or foreign particles through to your bloodstream.

Modern lifestyles place a lot of stress on the gut in the form of poor diet, medications, alcohol, infections and environmental toxins, leading to chronic irritation, inflammation and ultimately the breakdown of the intestinal barrier.

This delicate layer that should be selective and tightly regulated, now has tiny pin-prick like holes in it that allow foreign substances such as undigested foods, bacteria, yeast and toxins to cause an immune response.

As this scenario progresses over time, a variety of conditions can arise, including acne, allergies, asthma, fatigue and joint pain, or even more serious ones such as Hashimoto’s, Graves’ Disease, Psoriasis and other autoimmune conditions.

Triggers of Leaky Gut

The most common triggers of Leaky Gut are:

Stress

Diet

Infections

Toxins

Medications

Trigger: Stress

Stress is a significant trigger and mediator in the development of Leaky Gut. According to Chris Kresser, LAc, “The biochemical changes that occur in times of stress have significant and immediate impact on gut function.”1

Once your body perceives a stressor, whether it’s work, infection, exercise, food or toxin, it mounts a biochemical response that results in increased gut permeability, mediation of inflammation, increased sensitivity to pain, altered gut motility and changes to the gut microflora. Over time this can lead to significant changes in GI function.

Kresser states that “Experimental studies have shown that psychological stress slows normal small intestinal transit time, encourages overgrowth of bacteria, and even compromises the intestinal barrier.”1

These changes provide the gateway for other triggers to wreak havoc, as larger food particles, toxins, and pathogens enter the bloodstream through the gut, and thus the immune response occurs.

Trigger: Diet

While the stresses of work and family are of noteworthy significance, the food that you eat is actually the biggest daily stressor, as perceived by your body, according to Dr. Robert Rountree.5

Common gut-damaging foods include:

Gluten: A protein that has been hybridized (changed from its original form) to the point that your body sees it as foreign and reacts to it.9,10

Sugar and Refined Carbohydrates: Support yeast overgrowth and promote bad bacteria over good bacteria.

Alcohol: Alcohol and its by-products are direct toxins and irritants to the GI mucosa. It’s also linked to yeast and SIBO infections.

Food Sensitivities and Allergies: Gluten, Dairy, Corn, Soy, Yeast, Eggs, and Nuts are the most common offenders. With Leaky Gut, larger food particles enter your blood and the immune system responds. Since you’re likely eating very frequently, the result can be a continuous cycle of inflammation and immune upregulation.

Lectins and Phytates: Nutrient blockers that are produced by plants for survival that cause mineral malabsorption and alter the gut lining leading to immune activation. These are widespread in grains, legumes, and nuts.9,10

Conventional Dairy: The protein A1 Casein damages the gut lining, and according to Dr. Josh Axe, pasteurization causes degradation of enzymes that are critical to digestion of lactose.11

Trigger: Infections

GI infections such as Candida (yeast), parasites, H. pylori, and SIBO (small intestinal bacterial overgrowth) release toxic metabolic products that cause inflammation to the gut lining, as well as the breakdown of its physical barrier.

This toxic process also makes the intestines more hospitable to other pathogens, leaving you vulnerable to additional infections.

The presence of these GI infections also contributes to dysbiosis, or the imbalance of the bad gut flora over the good flora, essentially wiping away another level of defense against invaders and allowing the toxic environment to flourish.

Infections such as Lyme Disease and other tick borne illnesses, as well as certain viruses, can also play a role in the development of Leaky Gut, by contributing to processes that alter normal digestion and elimination, as well as perpetuate inflammation.16

Infections can also further complicate the situation through molecular mimicry.

Molecular mimicry occurs when the body mistakes a self-molecule for a foreign molecule and in error mounts an immune attack on its own tissue.14

A classic example is the bacteria Klebsiella attacking the joints, resulting in Ankylosing Spondylitis.15

Due to molecular mimicry, bacteria and parasites are often found to be root causes in the development of various autoimmune conditions.14, 15

Trigger: Toxins

In addition to the toxins produced from bacteria, yeast, and parasites, your body is exposed to an excessive amount of daily contaminants.

According to the EPA there are over 70,000 chemicals in U.S. commerce today.12 Some common ones include:

Toxins can damage intestinal cells, alter the gut nervous and immune systems, or even kill beneficial bacteria. The worst effect however, may be that these toxins are being reabsorbed and recirculated rather than eliminated from your body.

Even the hormones in your body can act as toxins because they can be re-absorbed into circulation if the flora is imbalanced and the gut is permeable.

Trigger: Medications

Anti-inflammatories, antibiotics and acid blocking drugs are the main medication-type contributors to Leaky Gut.

NSAIDs actually block the production of prostaglandins, which are substances that can mediate pain, but that are also critical to rebuilding the lining of the intestines.

According to Dr. Leo Galland, NSAIDs can further cause damage by sensitizing bacteria and altering the GI flora.13 He states, “If you use a full therapeutic dose of NSAIDs for 2 weeks there is a 75% chance you will develop a leaky gut that will not go away when you stop taking the drug.”13

Along with killing pathogens, antibiotics also kill the good bacteria, creating the potential for yeast overgrowth, which directly causes and perpetuates Leaky Gut.

Acid blockers decrease the amount of stomach acid produced. This results in suppressed and incomplete digestion of food, which allows large particles through the intestines and into the bloodstream. This increases the likelihood of immune system reaction. Further, decreased stomach acid leaves you vulnerable to pathogens, as there isn’t enough acid to kill them.

If you’re experiencing symptoms that lead you to suspect Leaky Gut, you should address them quickly.

According to Dr. Tom Sult, “As the condition of the gut degrades, the health implications can become serious.”6

Minor Symptoms tend to be largely limited to the gut early on in the condition, where as a more progressive case will have symptoms outside of the gut.6

The more symptoms that you have, the higher the correlation to an increased immune system response and the subsequent possibility to develop more serious conditions that can be difficult to reverse, such as autoimmune conditions.

Every single autoimmune condition is thought to have the same root cause: Leaky Gut. Dr. Alessio Fasano’s research has been integral in identifying this linkage. In his 2012 paper titled “Leaky Gut and Autoimmune Disease,” he states, “In addition to the genetic predisposition and exposure to triggering non-self antigens, the loss of protective function of the mucosal barriers that interact with the environment (mainly through the GI and lung mucosa) is necessary for autoimmunity to develop.”2,4

Dr. Leo Galland explains that even though you have a leaky gut, the cells of the intestinal lining replace themselves every 3-6 days.13

This means that once you eliminate the contributing triggers and root causes of Leaky Gut you can repair the intestines fairly quickly. The hard part can be identifying all of the causes and eliminating them.

Functional Medicine’s approach to the treatment of Leaky Gut is the 5R Program:

Remove the sources of irritation and inflammation:

Eliminate foods that contribute to leaky gut. Completing an elimination diet for 3-4 weeks is a good place to start.

Using a food diary is a great tool to identify food sensitivities when you add them back in. If you add them back in and have any type of reaction, you should keep them out until your gut is fully healed.

Try to eliminate the use of medications known to contribute to leaky gut, if you can.

Reduce toxin exposure by eating organic when possible, using cleaner personal care and home products, and filtering your home air and water. Many green plants provide natural toxin filtration.

Remove all sources of parasitic, fungal, and bacterial infections in the gut. If you take care of these without resolution of symptoms, look into viruses and other infections such as tick borne illnesses.

Replace the nutrients that your body needs to heal:

Using digestive enzymes and betaine hydrochloride to allow for proper breakdown and absorption of nutrients.

Taking a good multivitamin can help restore nutrients while your body is still not completely digesting and absorbing food.

Glutamine is an amino acid that is the primary source of fuel for intestinal cells. Supplementing with glutamine at 5-10g twice daily can help heal the gut lining faster.

Omega-3 fatty acids found in fish oils can help decrease inflammation taken at a dose of 2-4 g per day.

Supplements that contain Slippery Elm, Marshmallow Root, Aloe, DGL, and Zinc Carnosine are soothing to the gut mucosa. Use these cautiously as some of them can cause GI distress in people with certain dietary restrictions and autoimmune conditions.15

Reinoculate with good bacteria to restore the flora:

Using a high quality probiotic with at least 50 billion CFU twice daily will help restore the gut flora. Lactobacillus and Bifidobacter species are best.

Fermented foods such as sauerkraut, kimchi and kombucha, as well as kefir and yogurt (you can use dairy or non-dairy based) contain live, active cultures that will help the good bacteria stick around.

Prebiotic fibers and resistant starches provide the nutrients that support the healthy flora and maintain intestinal health.

Repair the gut lining and normal physiological functions.

Taking many of the supplements described in #2 and #3 will help repair and rebuild the gut lining.

In addition, it’s important to also repair the normal physiological processes of digestion, or you risk developing a leaky gut again. This includes using betaine HCl to increase stomach acid, digestive enzymes to assist the pancreas, intestines and liver until they produce adequate levels on their own, and sometimes ox bile to assist the liver in the digestion of fats.

Additionally, motility, or the ability to keep waste and toxins moving through the GI tract, often needs to be repaired and restored.

Ginger and d-limonene are good agents to stimulate GI motility. Exercise and movement are also great ways to keep the bowels moving.

Chronic inflammation = disease. This is a profound statement that has broad ramifications for health and disease management everywhere.

If you look at the root causes of almost every single disease and death, you’ll notice that chronic inflammation is a player in the process.

Some inflammation is good—in fact, it’s a normal, healthy biological process. It’s only when inflammation goes unchecked for extended periods of time that it becomes a big problem.

Think of inflammation as a smoldering ember. If you have a few embers in one room of a 10-story building, it’s a small problem that’s contained. But if you have embers in every room on every floor of that 10-story building, now there’s a problem. Just a little puff of air might rekindle these embers into an actual fire again. Eventually, the heat from this small fire could grow, and the whole building could go up in flames.

This is similar to what happens in the body. A minor infection might cause a fire that turns into smoldering embers, and these embers die out when the infection is gone (if you have a healthy immune response).

If you’re stressed out, not exercising or sleeping well, or have poor nutrition, imbalanced hormones, and GI problems, there’s a good chance you have smoldering embers burning throughout your body, creating a low-level systemic fire.

If you don’t identify the causes of these small fires, they’ll wreak havoc on your body and cause full-blown diseases like diabetes, heart disease, cancer, Alzheimer’s, Parkinson’s, dementia, stroke, autoimmune conditions, or hundreds of other major diseases.

The good news is that the power to change this is in your hands, because every action you take each day either contributes to health or causes disease.

What Exactly is Inflammation?

Inflammation is a big buzzword in the world of health now, and rightfully so. The word inflammation comes from the latin word “inflammare,” meaning “to ignite,” and it’s your body’s response to danger signals.

Classically, inflammation describes the body’s immune response and biochemical processes to remove harmful stimuli, such as pathogens, toxins, irritants, or even damaged cells in an attempt to preserve itself and heal. Then we have the physical manifestations of inflammation: calor (heat), rubor (redness), dolor (pain), tumor (swelling), and loss of function.

This process is apparent when you have a cut on your arm, a bad sunburn, or a pimple. It’s less obvious when you have a viral or bacterial infection, since you can’t see the signs. What we’ve described here is acute inflammation. Acute inflammation is a normal process necessary for life; it allows you to survive scrapes and infections. It has a beginning and an end.

Conversely, chronic inflammation persists without end in response to hidden infections, toxins, chemicals, and/or foods or from lack of counter-regulatory mechanisms (chemical “off” switches) in the immune system that should turn inflammation off.2 Persistent cellular stress or dysfunction caused by a high calorie, low nutrient diet, oxidative stress, and hormone imbalances perpetuates this process.

Chronic inflammation is never a good thing. The major danger with chronic inflammation is that it’s silent, causing destruction for years or decades before it’s noticed (usually as the first signs of a disease), leaving significant damage in its wake.1 It could be raging inside you at this very moment without you even noticing. This kind of inflammation is what underlies almost every chronic illness and disease known to man.

Acute and chronic inflammation share a common origin, although they end with two very different products. The main differences between the two processes are:5

Acute Inflammation:

Elimination or isolation of the stressor (infection, toxin, chemical, etc.)

Destroys cells and tissue over time (like the degeneration of joints in arthritis)

Long duration (months to years)

Often unnoticeable or hidden

How Does Inflammation Occur?

The inflammatory process is a complex symphony of the response of the immune system and its interaction with many different types of cells and biochemical signals.

There are two main branches—the innate immune response, which occurs quickly and is more simple and nonspecific, and the acquired immune response, which occurs more slowly, as it’s more specific and has memory (so when you encounter the same trigger, such as a virus, your body is prepared for the attack).

Triggers, such as infection or injury, induce a series of biochemical events. Numerous substances are released simultaneously by the injured tissues, causing changes to the surrounding tissues.6

Remember our 10-story burning building? You can think of your injured tissue doing this just like you would turn on the sprinklers to dampen the fire and alert the fire department.

There are many chemical messengers that function in this process; however, the important ones to note are histamine, serotonin, bradykinin, lipid (fatty acid) derived mediators, cytokines, and acute phase reactants.

These chemicals are the “fire department,” with their many tools to put out the fire. They’re responsible for actions such as swelling (increased leakiness of the blood vessels), relaxation (dilation) or tightening (constriction) of the blood vessels, airways, and intestinal smooth muscle, and sending out chemical messages that turn on genes, recruit more helpers to the scene, or produce substances involved in the inflammatory process itself.

Histamine: Most people are aware that histamine is involved in the inflammatory response given the significant notoriety of antihistamines with allergies.

What many people are unaware of is that it also functions as an excitatory (stimulating) brain neurotransmitter producing wakefulness and anxiety, which is why many people with severe allergies, hives, or GI infections don’t sleep well.5,6 Its highest concentrations are in the gut, skin, lungs, and central nervous system (CNS), where many of the symptoms are felt.

Serotonin: This substance is best known as a brain neurotransmitter responsible for keeping you happy, calm, and well-rested. It’s also known for its role in the gut, affecting motility (how food and waste move through) and secretion of digestive chemicals. 95% is produced in the gut, and it can be significant in inflammatory GI disorders. You know that feeling when you get butterflies in your stomach, then have anxiety and maybe diarrhea? That’s serotonin. Together, histamine and serotonin are some of the first responders in the inflammatory movement.3,5

Bradykinin: This protein isn’t well-known by name; however, you’ve felt its effects many times before, since it’s a significant chemical in the inflammatory process. Bradykinin causes many of the actions of the inflammatory process (swelling, pain, blood vessel dilation, etc.) itself, or it signals other cells to participate and release their chemicals. It can also increase histamine release, making a response more intense.4 Bradykinin is most often released from tissue damage or exercise.4

Lipid Derived Inflammatory Mediators: This is a fancy term for chemicals derived from the oxidation (the loss of electrons from molecules—think rust) of the omega-6 fatty acid, arachidonic acid (AA), and omega-3 fatty acids’ eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).

Like histamine, you may have heard of some members of this group of chemicals before, since prostaglandins and leukotrienes are called out in the inflammatory process in advertisements.

They’re short-lived, signaling molecules found in most cells that modulate all aspects of the inflammatory process, including the resolution of inflammation, and they have system-wide influence on nerve transmission, mood, and hormone secretion.5,7,8

Cytokines: These are the primary chemical switches that turn the immune response on and off. They activate and recruit other cells to the immune response and assist in antibody production. Cytokines are responsible for fever production and participate in the allergic response, as well as antimicrobial and antiviral activity.5,7,8

Tumor necrosis factor alpha (TNFɑ) is one of the most important cytokines involved in systemic inflammation; it regulates other cells of the immune response. It has antiviral and anti-tumor activity, and dysregulation is implicated in obesity, Alzheimer’s, cancers, depression, and IBD.5,7,8

Acute Phase Reactants (APR): APRs are a category of proteins produced in the liver that increase or decrease in response to inflammation. Some of the most notable are C-reactive protein (CRP), ferritin, and fibrinogen.

CRP increases rapidly with inflammation and marks damaged cells, making them easier to identify for elimination. Once it rises, it’s cleared rapidly from the system.11,12

Ferritin, an iron carrier protein, increases in response to most infections, except a few bacterial strains.11,12 Fibrinogen is a coagulation factor promoting clot formation that increases with inflammation. ESR (erythrocyte sedimentation rate), also considered to be an APR, describes the rate at which red blood cells fall in a one-hour period and correlates to fibrinogen levels.11,12

Other aspects of the inflammatory response involve the formation of antibodies to specific antigens and the blood clotting system. Antigens are proteins found on all cell surfaces, and when the immune system identifies them as foreign, it forms a corresponding antibody to it. Antibodies either neutralize the foreign invader or prepare it for phagocytosis (engulfing of a foreign particle for elimination).9

The process of blood clotting (coagulation) involves a group of proteins that convert clotting factors (such as prothrombin, thrombin, and fibrinogen) to a fibrin clot. The pathway is linked to inflammation since the clotting process, which occurs outside of a cell, can trigger the inflammatory signaling inside of a cell.

These processes operate in a feedback loop that promotes one another, and when left uncontrolled, this loop can be a problem in chronic inflammation—especially cardiovascular disease, clotting disorders, and hormone imbalances.10

All of these chemicals signal in various ways to elicit the response that produces redness, swelling, heat, immobility, and pain—as they should—but the body is smart and knows that the inflammation must end.

Dr. Robert Rountree, MD, states, “Simultaneously, the body activates biochemical counter-regulatory pathways (off switches) that produce anti-inflammatory mediators such as lipoxins, protectins, and resolvins. These are lipid mediators that are made on demand from the omega-6 fatty acid, arachidonic acid (AA), and the omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) specifically for the purpose of turning off the inflammatory response.”2

This pro- and anti-inflammatory balance is the adaptive immune process, and it’s what should happen after an acute injury where the body identifies and responds to the insult or invasion, then repairs the injury and the process ends.

This process becomes a problem in two scenarios. First, when this response is exaggerated, producing a severe allergy or anaphylaxis. Second, when the cause of acute inflammation persists without end or the counter-regulatory mechanisms (anti-inflammatories) are compromised, producing chronic inflammation. Acute inflammation from a wound, infection, or a food allergy will cause systemic, chronic inflammation if not identified and treated.

Additionally, when the normal mechanisms that quench inflammation are decreased (or pro-inflammatory processes are increased), chronic inflammation will ensue. Inflammation begets inflammation, so it’s important to identify the triggers to stop perpetuating the cycle.

Functional medicine cardiologist Dr. Mark Houston says it best: “The body has a limited number of options to deal with an unlimited number of insults.”

Triggers of Inflammation

There are many triggers of inflammation, and often several are operating in concert together, propelling the cycle forward.

What these triggers have in common is that they generate free radicals or reactive species from oxidative stress and/or the inflammatory chemicals discussed previously.

Free radicals and other reactive species are produced as a product of oxidation, which involves the removal of one electron from an atom, rendering it unstable or reactive.

Your body obtains energy by combining fuel from the foods we eat with the oxygen we breathe in a controlled metabolic process that yields potentially dangerous oxidative byproducts that damage DNA, mitochondria, proteins, and cell membranes if we don’t have the appropriate antioxidant and anti-inflammatory mechanisms in place.

Oxidative stress isn’t only generated when you eat, but also during exercise, detoxification, and when the immune system is activated in the inflammatory response.

The good news is that many of these triggers are modifiable lifestyle factors or conditions that can be tested for, identified, and reversed. Dr. Mark Hyman, MD explains the importance of identifying the causes, explaining, “My job is to find those inflammatory factors unique to each person—to see how various lifestyle, environment, and infectious factors spin the immune system out of control, leading to a host of chronic illnesses.”16

The most common triggers are:

Diet

Stress

Dysbiosis

Infection

Hormone imbalance

Toxins

Trigger: Diet

Diet, for most people, is the single most important lifestyle change that can significantly impact chronic inflammation.

The food you eat sends chemical messages to your genes, which will either turn up or turn down inflammation. The following are pro-inflammatory foods (so you should think about avoiding them):

Gluten: A protein that has been hybridized (changed from its original form through breeding, not genetic modification) to the point that your body sees it as foreign and reacts to it. This reaction upregulates the immune system and will continue until the gluten is removed.

Food Sensitivities and Allergies: Gluten, dairy, corn, soy, yeast, eggs, and nuts are the most common offenders. When your body is constantly bombarded by these irritants, leaky gut, or increased intestinal permeability occurs, allowing larger food particles to enter your blood, and the immune system responds. Since you eat several times a day, the result can be a continuous cycle of inflammation and immune upregulation until the source is eliminated.

GMOs: Genetically modified foods that your body can’t identify can trigger an immune response similar to a food sensitivity. The largest GMO crops are corn, canola, soy, sugar beets, zucchini, yellow squash, and papaya, many of which are pro-inflammatory to begin with.

According to Dr. Tom O’Bryan, BT (botulinum toxin) in GMO foods has been shown to cause severe intestinal permeability in insects.23 Dr. O’Bryan also warns that BT toxins have been found in maternal and fetal blood, so we know they’re getting absorbed when we consume them.23

Sugar and Refined Carbohydrates: Your body is only designed to handle small amounts of natural sugar, and there are several issues with exceeding this amount.

First, refined sugar and carbs are genetically unfamiliar, which is a problem.11 Second, when you consume sugar or carbs, especially in large amounts frequently, it causes a rapid rise in blood sugar. If you need fuel, your body will use it; otherwise, it gets stored in muscles as glycogen or in fat cells.

If you have decreased insulin sensitivity or diabetes, this storage process is inefficient, leaving sugars in circulation, which spells trouble because it leads to the formation of free radicals from increased oxidation. Too much insulin release is pro-inflammatory as well.11 Excess sugar also promotes yeast overgrowth and dysbiosis (higher amounts of bad bacteria versus good bacteria), which further encourage inflammation.

Conventional Dairy and Meats: Meat and dairy raised in a conventional manner (grain-fed versus grass-fed) have the same health problems humans do, since they weren’t meant to eat grain.

Consuming all of these grains leads to a higher production of pro-inflammatory omega-6s and fewer omega-3s in these animals. When you eat them, you’re increasing your levels of pro-inflammatory fats as well. Some of the proteins (especially A1 casein) found in dairy are known to promote inflammation according to Dr. Kelly Brogan.13

Bad Fats: Most Americans have a dietary (and bodily) imbalance in their omega-6/omega-3 ratio, which causes your body to be in a pro-inflammatory state. Corn, safflower, sunflower, soy, and peanut oil are all omega-6s. Also, healthy fats such as olive oil, nuts, and nut oils are degraded (oxidized) when used in cooking at high heats or when storing them improperly, leaving them vulnerable to oxidation due to air exposure.

Processed Foods: These foods contain additives, colorings, dyes, and preservatives that your body sees as irritants or toxins. Because these foods are foreign to your body, they may induce an immune response.

Advanced Glycation End-Products (AGEs): AGEs are produced as a result of a glycation reaction, when a sugar reacts with a protein or fat. AGEs form stable molecules that embed in tissues, causing oxidative damage, and are difficult for the body to get rid of. In food, they occur by cooking at high heat as with grilling, barbecuing, deep frying, broiling, and searing—basically anything that gives color or texture. The higher the heat, the more AGEs that form.

Meats, sugary foods, and processed foods are particularly high in AGEs. They also occur naturally in your body, and the higher your blood sugar, the more these will form, so limiting sugars and maintaining blood sugar is important. Fructose is particularly reactive, so limiting daily intake to 25 g or less is best.15

Stress as a trigger for inflammation is just as important as diet is. It could be argued that stress is more so, actually, since stress comes in so many different forms that all add up when combined in our hectic modern lives.

Emotional Stress: Work, finances, relationships, job change, marital change, death of a loved one, birth of a child, etc. This is what people commonly refer to as “stress” in their lives. These stressors are often the hardest to control and can have a profound impact on healing.

It’s important to note that the body doesn’t discern between different types of stresses. Similarly, it can’t perceive the difference between good stress (birth of a baby or a new job) and bad stress (loss of job, divorce) and will react the same.

Anything that disrupts homeostasis will be perceived by the body as a stressor, and it will act accordingly in an effort to keep you alive.

Stress, like inflammation, is good when the response is appropriate and controlled. It initiates the ‘fight or flight’ response meant to keep you alive when danger is present (like when you encounter a bear and need to escape), like blood rushing to your brain to keep you focused. Simultaneously, non-essential functions like digestion and reproduction are decreased.

Just like with inflammation, counter-regulatory off switches exist so that the stress response ends. This was great in paleolithic times; however, in modern life, we have an overabundance of stress that doesn’t seem to stop.

Our stress response never ends, disrupting the mechanisms that should bring us back in balance. This causes several physiological changes that potentiate inflammation.

Chronic stress causes the sympathetic nervous system to be upregulated and increases levels of the stress hormone cortisol.

Over time, constant cortisol elevation leads to cortisol resistance, where the body must pump out even more to meet the same metabolic demands.

When this occurs for extended periods of time, cortisol levels become chronically low and adrenal fatigue develops. Cells of the immune system become insensitive to cortisol’s regulatory effect and don’t respond, which promotes inflammation.17

Not only does stress promote inflammation, but it also lowers immunity. A 2012 study by Dr. Sheldon Cohen revealed that prolonged exposure to a stressful event was associated with the inability of immune cells to respond to hormonal signals that normally regulate inflammation.

In turn, those with the inability to regulate the inflammatory response were more likely to develop colds when exposed to the virus. “The immune system’s ability to regulate inflammation predicts who will develop a cold, but more importantly it provides an explanation of how stress can promote disease,” Cohen said. “When under stress, cells of the immune system are unable to respond to hormonal control, and consequently, produce levels of inflammation that promote disease. Because inflammation plays a role in many diseases such as cardiovascular, asthma, and autoimmune disorders, this model suggests why stress impacts them as well.”17

Dysbiosis occurs when there’s an imbalance between the beneficial and harmful organisms in you body, especially the gut.

Normally, you have helpful bacteria and even some yeast that help you digest food, produce nutrients, and protect you from harmful organisms as well as inflammation.

Dysbiosis arises when there’s a general imbalance between the good and bad flora, or when there’s a pathogen or infection present, such as SIBO (small intestinal bacterial overgrowth), Candida (yeast), or a parasite.

Additionally, an increase of certain gram-negative bacterial species promotes inflammation because most of them contain lipopolysaccharide (LPS) in their outer cell membrane. This is an endotoxin—as the name suggests, that’s bad because it promotes inflammation by eliciting a strong immune response and contributing to leaky gut (increased intestinal permeability).

SIBO arises when there are more bacteria in the small intestines than there should be. Normally, there are much fewer bacteria in the small intestines than the colon since the small intestines function more in digestion and absorption of nutrients. SIBO infections can promote inflammation through the imbalance of bacteria, leaky gut, nutrient malabsorption, and the imbalance of histamine and serotonin.

Candida (yeast) is a fungus that aids in digestion and nutrient absorption. It’s opportunistic, becoming pathogenic and increasing in numbers if your immune system is compromised from stress or illness, or if your diet is high in sugar and carbohydrates.

Research shows that Candida infection delays healing, and the inflammation from the infection promotes further colonization of yeast, creating a vicious cycle of low-level inflammation and infection.19

Parasites are literally everywhere. Giardia (sometimes called beaver fever) and Cryptosporidium are some of the parasites that make the headlines occasionally, even though there are a plethora that exist. Acute parasitic illness manifests with the typical symptoms of diarrhea, vomiting, stomach pain, bloating, fever, and malaise. Most resolve with the normal immune response.

Chronic infections, however, can range from asymptomatic to severe, with blood and mucus-filled stools, profuse diarrhea, and malnutrition. These infections contribute to inflammation through decreased nutrient absorption, constant immune system attack, and interrupted sleep patterns.

Trigger: Infections

Infections other than typical GI infections are also a common source of inflammation; they often go undetected for long periods of time, allowing them to wreak havoc on the body and the immune system.

Some more obvious infectious agents are mold (fungal infection), Lyme and other tick-borne illnesses, and chronic viral infections like the Epstein-Barr virus (EBV). Less obvious and often hidden infections that can go undetected for years are abscesses from trauma or surgery, but especially dental procedures.

Mold: Describes a group of fungi that are ubiquitous. Their spores are often airborne and deposit everywhere, which is why you find white or green fuzzy patches on your produce or bread. It can be associated with dysbiosis or systemic infection.

The toxins (mycotoxins) that come from mold are very harmful, producing symptoms ranging from mild to severe fatigue, sore throats, nosebleeds, headaches, diarrhea, brain fog, food sensitivities, and memory loss. These symptoms often mimic other conditions, which delays diagnosis and allows inflammation to proliferate.

Tick-Borne Illness: Tick-borne illnesses are becoming more prevalent and are often hard to diagnose. Lyme disease, an infection acquired through the bite of a tick infected with the bacteria Borrelia burgdorferi, is the most well-known of this type of infection. Babesia, Rickettsia (Rocky Mountain Spotted Fever), Ehrlichia, and Bartonella are also frequently identified infectious bacteria from tick bites. These infections not only take a toll only the immune system itself, but also the gut, contributing to decreased GI motility and dysbiosis.

Chronic Viral Infection: A common but not often talked about cause of systemic inflammation. The problem with viruses is that they can remain latent (inactive) for extended periods of time and don’t reactivate until there’s a trigger.

Cytomegalovirus (CMV) and Epstein-Barr virus (EBV) are two herpes family viruses that can remain latent after initial infection and only become active again under stress or immunosuppression. EBV, the infectious agent in mononucleosis, is also associated with the development of several types of cancer and autoimmune conditions. Chronic activation of the immune system produces inflammation with undetected viruses.

Abscesses: Can occur after any type of tissue injury such as trauma, surgery, infection, or dental procedures (especially a root canal). They form when incomplete healing takes place, either from a physical barrier or because the body can’t mount an appropriate immune response to kill off the bacteria.

The constant activation of the immune system produces chronic inflammation, and many systemic symptoms can go on for years—this is one of the most difficult causes to detect, since most people forget about a procedure or discount an injury.

Trigger: Hormone Imbalances

Hormones need to be maintained in a delicate balance for proper function. When any hormone is too high or too low, many of the other hormones shift as well, causing imbalances throughout the system.

Cortisol, DHEA, insulin, estrogen, progesterone, and testosterone all have effects on each other, as well as other hormones, which all impact inflammation.

Generally, androgens (testosterone and DHEA) have a suppressive effect on the immune response and inflammation while estrogens increase the immune response. Research suggests:

“Low levels of androgens as well as lower androgen/estrogen ratios have been detected in body fluids (blood, synovial fluid, saliva) of both male and female rheumatoid arthritis patients, supporting the possibility of a pathogenic role for the decreased levels of the immune-suppressive androgens.

“Several physiological, pathological, and therapeutic conditions may change the sex hormone milieu and/or peripheral conversion, including the menstrual cycle, pregnancy, the postpartum period, menopause, chronic stress, and inflammatory cytokines, as well as use of corticosteroids, oral contraceptives, and steroid hormonal replacements, inducing altered androgen/estrogen ratios and related effects. Therefore, sex hormone balance is still a crucial factor in the regulation of immune and inflammatory responses.”

Adrenal fatigue with lowered cortisol and DHEA, estrogen dominance in women (with a relative low progesterone level), and low testosterone in men (with a relative elevation in estrogen) all create an imbalance that skews the body to a pro-inflammatory state. This state can be further exacerbated by poor blood sugar regulation.

Proper blood sugar regulation is critical in maintaining hormone and inflammatory balance. Excessive insulin is pro-inflammatory, as is the activity of the enzyme aromatase, which is increased by insulin.

Aromatase is the enzyme that converts androgens to estrogens, and it has a great deal of influence on the production and balance of sex hormones. Many cell types have aromatase activity, but adipocytes (fat cells) are of particular interest because the more you have, the more active aromatase is.

Toxins are virtually all around us in modern life, from pollutants in the air we breathe, the water we drink and bathe in, and the foods we consume to the products we use to clean ourselves, our homes, and our possessions. They can also be produced in the cooking process and in our guts.

The thyroid is particularly sensitive to chemicals and oxidative stress. With increased exposure, thyroid function decreases, producing a hypothyroid state that triggers weight gain and supports inflammation.

Toxins you’ll want to minimize exposure to include heavy metals (mercury, lead, aluminum, arsenic, cadmium, etc), tobacco smoke, air pollution outside and in the home, pesticides (organophosphates), herbicides, plastics (BPA, BPF, BPS, phthalates, polystyrene, PVC, etc.), chemicals (toluene, xylene), and preservative and chemical-laden personal care products and foods. This list is a good place to start, but it’s not exhaustive.

Anything that ends in ‘itis’ means that it’s inflamed. Appendicitis literally translates to “inflammation of the appendix.” Other than the obvious ‘itis’ conditions, here are other symptoms associated with chronic inflammation:

The treatment of inflammation can seem daunting since there are so many different causes.

The easiest approach is to clean up the diet, add in nutrients and make lifestyle modifications.

If you’re not getting the desired results, do some further investigating into root causes such as food allergies, autoimmunity, GI infections, impaired detoxification, toxic exposures (mycotoxins, heavy metals, chemicals), hidden infections such as Lyme or EBV, and proper hormone balance.

As Dr. Josh Axe notes, “Antioxidants are self-sacrificing soldiers that donate an electron to neutralize free radicals and are consumed in the process.” He suggests eating brightly-colored vegetables and fruits, cocoa, and green or white tea.25

Dr. Hyman also recommends getting an oil change. “Eat healthy fats from olive oil, nuts, avocados, and omega-3 fats from small fish like sardines, herring, sable, and wild salmon.”27 These fats are anti-inflammatory and promote a healthy omega 3:6 ratio.

An elimination diet may help you find out if there are foods contributing to your inflammation. Eliminate these foods for at least 30 days and note how they make you feel when you add them back in.

Cooking your foods at a lower heat will help them retain nutrients and avoid forming harmful substances. Author Mark Sisson recommends poaching, boiling, steaming, braising, baking, or using a pressure cooker or crock pot.28 If you really want to grill or cook at high heat, marinating with olive oil, citrus, and herbs or spices will reduce toxin formation.

Nutrients and Supplements: There are many anti-inflammatory nutrients found in fruits, vegetables, teas, coffee, herbs, and spices. Here are some that can be helpful if you experience inflammation:

According to neurologist Dr. David Perlmutter, turmeric (curcumin), green tea extract, pterostilbene (from resveratrol), glucoraphanin (from broccoli), and coffee activate an important anti-inflammatory pathway (Nrf2), and taking these nutrients as supplements can be far more effective at increasing antioxidant production than typical antioxidants.26

Lifestyle Modifications: These are some of these easiest and most effective ways to reduce inflammation. Incorporating them into your life as habits will help promote long-term inflammation management.

Stress reduction: Stress is one of the biggest contributors to chronic inflammation, and managing it essential to lifelong health. Identifying stressors is the first step. Once you’ve done this, create boundaries, say “no” when you have to, and make sure your feelings are heard and understood.

Sleep: Getting adequate sleep is essential to healing. Aim for a minimum of 8 to 9 hours per night, and try to get to bed by 10 PM. Sleep in a dark, cool, and quiet room for the most restful results.

Unplug: Being constantly tuned in to your phone, computer, iPad, tablet, or TV exposes you to radiation and can also alter your sleep cycle due to blue light stimulation.

Detox your personal care products: If you won’t eat it, don’t put it on your body. Opt for natural or organic lotions and creams, shampoo, conditioner, toothpaste, deodorant, and fragrance. You can make many for low cost at home from coconut oil, essential oils, and other common household items.

Detox your home: Look for natural and organic products here too to avoid toxic chemicals. Many cleaners are now being made from enzymes and plant soaps. You can also make homemade ones from vinegar, lemon juice, baking soda, essential oils, and more. Keeping lots of green plants in the home helps detox the indoor air as well. Look for rubber plants, aloe, peace lilies, areca palm, golden pothos, and English ivy.

With a little detective work and some requisite effort, you could be well on your way to putting out the fire from within your own body that’s robbing you of your health. Learn to listen to your body and to notice the obvious signs. Your body is an incredible machine that’s designed to want to heal. All it asks of you is to provide it with an environment that’s conducive to this objective.

Nothing says good morning quite like pooping into a toilet hat and transferring part of that specimen, using a spoon, into a test tube. While this might sound a little gross on the surface, it can tell you a lot about your health.

The condition of your gut and how well you can absorb, utilize, and eliminate nutrients represents the foundation of health in your body. Digestive symptoms manifest as anything from brain fog, fatigue and acne, to diarrhea, gas, and bloating. The symptoms are vast and can be confusing, so clearly knowing what you’re looking for helps.

Symptoms of Digestive Problems

Understanding your symptoms can be a useful guide for choosing the correct test.

Choosing digestive tests can be a daunting task, especially when the symptoms seem to be coming from everywhere in your body. Starting off with the basics and expanding from there is always a good way to proceed when doing any testing.

The first thing to consider is if the symptoms suggest an acute infection, such as parasites or food poisoning. If this is the case, then testing to identify the organism is best. This usually involves a stool test and/or blood testing.

If your symptoms are chronic or more vague, then approaching tests with a broader scope can more easily pinpoint the root causes (there are often many). Dysbiosis, malabsorption, nutrient depletion, and GI dysfunctions like increased or decreased transit time often occur together.

When using this approach, the first goal is to identify and eliminate all pathogens, because if they’re present, you’ll have dysbiosis. Next, identifying the composition of the gut flora and checking immune and gut function will help direct treatment in the healing and rebuilding phases.

Occasionally, things don’t go like you want them to and further testing is warranted. Some companies offer specialty tests for food sensitivities or allergies (like celiac), detoxification, specific toxin testing, and hidden infections. We’ll get to these types of tests later on.

Digestive Testing

General tests can be completed by lab companies such as LabCorp or Quest, as well as specialty labs:

Functional tests are more in-depth than standard digestive tests. They’re provided by specialty labs and often require a practitioner to request them for you:

Organic acids dysbiosis profile

Comprehensive digestive stool analysis (CDSA)

Intestinal permeability

Lactose intolerance breath testing

SIBO (small intestinal bacterial overgrowth) breath testing

Stool Testing

Stool testing is just what it sounds like—an examination of your stool for good and bad organisms, toxins, and the presence of blood.

Typically, stool tests incorporate a stool culture of common bacteria, microscopic analysis for yeast, fungi, parasites, and blood cells, and sometimes testing for toxins that organisms excrete, such as the Shiga toxins (E. coli) or Clostridium difficile toxins A and B.

Additionally, most of the functional/specialty labs do antibody tests for hard-to-identify organisms, such as Giardia lamblia, Cryptosporidium parvum, Entamoeba histolytica, and Helicobacter pylori as a part of their normal stool testing.

One of the big differences is that some labs offer one-day tests while others offer three-day tests. The benefit to three days’ worth of samples is that there’s a greater chance of identifying elusive GI organisms.

That’s not the whole story, though. While most labs rely on traditional methods to identify organisms, some labs offer PCR-based testing, which means they’re using DNA to identify and only require one sample.

Serum testing requires a blood draw, and the sample will be used to identify any organisms in your bloodstream. This may happen if you’ve had a systemic illness that may have spread from another area, such as the digestive or urinary tracts.

Bacteria, yeast, and other fungi are often identified in this manner. Yeast is especially important to consider here, because it’s opportunistic and will go beyond the limits of the GI tract in people with compromised immune function or co-infections.

This test is most likely to be conducted through a standard lab, at a hospital, or through your doctor’s office. It’s not something offered through specialty labs.

Antibody or Antigen Testing for Infections

Antibody testing is similar to serum testing in that it offers another means of identifying sometimes hard-to-locate organisms. Antibody testing can be done on blood or stool. When you have an infection, your body mounts an immune attack and creates antibodies against that specific organism’s antigen (the protein your body identifies as foreign).

Antibody tests measure your body’s immune response to an organism. This type of testing lets you know that there was an organism present at some moment in time, but it won’t necessarily tell you if it’s active, since antibodies can remain elevated even after the intruder is eliminated.

Similarly, antigen testing can identify the presence of an organism. Performing a stool antigen test for H. pylori is a preferred method, as it’s less invasive than other methods and is both sensitive and specific for active infection.

Antibody and antigen testing can be run through standard labs, as well as via BioHealth Laboratory, Genova Diagnostics, Doctor’s Data, and DRG Laboratory.

Organic Acids Dysbiosis Profile

Urinary organic acids measure the byproducts of your metabolic processes. Specifically, it’s measuring the metabolites produced by the bacteria and yeast living in your gut. This is a simple and non-invasive test, since it requires only a urine sample.

Intestinal bacterial overgrowth and yeast infections will cause elevated metabolites, and they’re also useful in assessing carbohydrate and protein malabsorption.

Urinary organic acid testing is available through Great Plains Laboratories and Genova Diagnostics.

Comprehensive Digestive Stool Analysis (CDSA)

Comprehensive digestive stool analysis is another way to evaluate the health of the GI tract. Using microbial growth-based cultures, biochemical assays, and microscopic evaluation, this thorough test assesses the status of beneficial and pathogenic microorganisms, including aerobic and anaerobic bacteria, yeast, and parasites. Specific analysis includes:

Identification of pathogenic bacteria, parasites, and fungi, and levels of beneficial bacteria

Protein, carbohydrate, and fat absorption via elastase and chymotrypsin levels, as well as the presence of meat and vegetable fibers and fats

Many of these markers can also be tested as smaller profiles or individual tests. The full test is offered by Genova Diagnostics and Doctor’s Data, while DRG Laboratories can do a pared-down version with their stool PCR testing.

Intestinal Permeability Testing

This test provides a method for verifying the presence of increased intestinal permeability, also called leaky gut. Leaky gut allows food particles, toxins, and products of dysbiosis to enter the bloodstream, where an immune response mounts and inflammation is produced. It’s implicated in many conditions, from IBS to autoimmunity.

One version of the test, the Lactulose-Mannitol test, requires you to drink a solution of the sugars lactulose and mannitol. The degree of permeability is assessed by the amount of sugar recovered in urine.

An updated version of permeability testing called Intestinal Antigenic Permeability Screening assesses IgA, IgM, and IgG antibody reactions to bacterial endotoxins (LPS) that have entered the bloodstream. It also measures the tight junction proteins zonulin and occludin that break down in leaky gut, as well as a cell structure component called actomyosin. This test may more specifically show the route of gut barrier damage.

Lactose intolerance is one of the most common food intolerances in the US. Consumption of dairy that causes gas, bloating, diarrhea, and abdominal pain is an indication for this type of test. Inability to break down the dairy sugar lactose because of a lack of the digestive enzyme lactase or intestinal irritation results in lactose malabsorption and digestive symptoms.

This test requires you to drink a lactose solution and then take breath samples over a period of several hours. It measures the amount of hydrogen and methane produced when undigested and absorbed lactose is fermented by gut bacteria.

Genova Diagnostics offers this test.

SIBO Breath Testing

Small intestinal bacterial overgrowth (SIBO) occurs when large amounts of bacteria are present in the small intestine, where there are normally very few. The small intestine is where absorption largely takes place, so there’s little need of bacteria.

The symptoms are similar to lactose intolerance, because the bacteria are fermenting undigested foods (especially carbohydrates) and producing methane or hydrogen. Bloating, gas, abdominal pain, diarrhea, and constipation are classic symptoms.

During this test, you consume solution of glucose or lactulose, and then breath samples are taken over a period of 2-3 hours. The test measures the amount of hydrogen and methane produced when undigested and unabsorbed lactose is fermented by gut bacteria. High methane is associated with constipation, and high hydrogen levels correlate with diarrhea.

Genova Diagnostic and Commonwealth Labs both offer this test.

Summary

There’s certainly no shortage of digestive testing for you to explore. If you don’t get answers from basic tests, perhaps it could be time to consider more functional testing. Many of the tests referenced above can be ordered through Direct Labs, and can shed much light on the root causes of your health symptoms- and like G.I. Joe used to say, knowing is half the battle.

As a lifelong sufferer of IBD, Jill had concerns that her baby could inherit a form of the disease as well. But back in 1995, when her daughter Mika was born, genetic testing wasn’t so accessible. In fact, not too long ago, genetic testing was an idea straight out of a science fiction movie. We could only fantasize about having access to the seemingly unreachable information that exists within our genetic code.

Fast forward to today. Technological advances now allow us to understand why we don’t tolerate caffeine or medications well, why there’s a scent to our urine after eating asparagus, and why we’re predisposed to certain diseases.

Genetic tests literally unravel your genes and read the story the DNA tells, which is your specific and individual blueprint, unlike anyone else’s. You now have the ability to see exactly what makes you, YOU.

We’re beginning an exciting period in history—an age of precision and personalized healthcare. Genetic testing can provide people like Jill (and you!) with the tools to attain this level of customization.

Should You Get Genetic Testing?

Genetic testing can provide you with the ability to customize and target your healthcare and lifestyle according to what’s found in your genetic blueprint.

For example, some of these tests can tell you how well you’ll respond to certain medications, noting if you’re a fast or slow metabolizer, which will allow for precise dosing according to your needs. This is powerful information, and with it needs to come understanding.

Yes, you now have the ability to find out if you have genes that make you more susceptible to a myriad of diseases such as breast cancer, diabetes, and Alzheimer’s. However, it’s important to understand that your genes are not your destiny.

It’s so significant that it’s worth repeating. Your genes are not your destiny.

The rare exceptions are certain inheritable genetic diseases such as cystic fibrosis or hemochromatosis.

Many people get this information and become paralyzed with fear that their results are their fate, but that couldn’t be further from the truth. Genes are permanent, but they represent only half the story.

Like everything else in your body, there are dynamic biochemical processes that occur every second of every day, and these influence how your genes are expressed.

You have control over this process – it’s called epigenetics.

Epigenetics

Epigenetic factors encompass all of the environmental influences that help regulate gene expression.

Simply put, every choice you make each day is a step toward either health or disease.

Think of your genes as the gun and the environment as the trigger. Bad choices cause the gun to fire, producing disease, and good choices keep the safety engaged, producing health.

This is profound information, since you have the power to influence whether or not the genes that predispose you to a condition, such as diabetes, actually produce the disease.

Avoiding sugar, exercising, and managing stress will go a long way in preventing that from happening.

Your positive lifestyle choices also influence your offspring, as it’s now known that not only genes are passed on, but some of the epigenome as well.

Which Genetic Test Do I Choose?

Genetic testing can be complicated, and many considerations need to be taken before you jump in.

First and foremost, ask yourself the following questions: Do you want to know this information? How will it impact your life? What will you do with this knowledge? Once you have this information there’s no turning back, so make sure you’re prepared for the results.

There are several ways to go about testing. Raw genotyping, also known as exome testing, analyzes your genome and provides you with your personal code as raw genetic information. This supplies an abundance of information that must be interpreted. After you interpret the results, you’ll have a myriad of information regarding many aspects of your health.

If you want to start smaller or only have an interest in certain areas of your health, such as detoxification function or cardiovascular disease risk, then SNP testing may be right for you. These tests interpret your SNPs, or single nucleotide polymorphisms, where a change (mutation) in your DNA results in an error in the code.

Raw Genotype Testing

Raw genotype testing is available from companies like 23andMe, deCODEme, and Family Tree DNA. This type of test analyzes your genes, which are made up of long sequences of DNA.

DNA is comprised of four base pairs that make up your genetic code: A (adenine), T (thymine), C (cytosine), and G (guanine). This is what the test reads.

This type of testing gives you raw genetic material that must be interpreted to make sense of it, and even then you’re somewhat limited, since the field is in its infancy. More factors need to be better understood to make complete sense of this information, and that’s on the horizon.

Several sites on the internet provide interpretation, including Genetic Genie, puregenomics.com, promethease.com, opensnp.org, and snpedia.com.

Similarly, if you know you’re a carrier for a certain inheritable disease, such as Tay-Sachs, Huntington’s, or cystic fibrosis, or if you want to know whether you are, genetic testing for specific conditions is also available. These tests are smaller panels that look for specific genes. Healthcare providers and genetic counselors provide this type of testing and result interpretation.

SNP Testing

Your genetic code is important because it provides the instructions for how your body works. Genes direct enzymes that control your metabolic functions. Mutations in the code produce changes in enzyme function. Some of these mutations, called single nucleotide polymorphisms (SNPs), can be tested for.

A SNP (pronounced “snip”) refers to a single mutation where one DNA base is swapped for another(remember, the bases are A, T, C, and G, and they form the backbone of the DNA molecule). Some SNPs occur and nothing happens. However, other SNPs alter enzyme function, which may have health implications.

For example, with the MTHFR A1298C SNP (found at the 1298th position), a C is in the location where an A should be. This changes the gene’s instruction manual and alters the way enzymes work (they may work slower or faster than usual).

This particular gene encodes for the enzyme methylene tetrahydrofolate reductase (MTHFR), which is vital to homocysteine metabolism. When this SNP is present, there can be up to a 30% decrease in enzyme function.

It’s important to note that you have two copies of each gene, and this reflects the degree of altered enzyme function. One copy is considered heterozygous (denoted +/- or -/+), and having two copies is called homozygous (denoted +/+). Being homozygous produces a more substantial change in enzyme functionality.

Many SNPs exist, and some can be tested for. SNP testing is often completed as a single test or as a panel focused on specific areas of metabolism or conditions.

The 2 MTHFR methylation SNPs are widely available now from many places, including LabCorp and Quest, as well as specialty labs like Spectracell. Complete methylation panels showing all of the related SNPs (like MTRR, CBS, ACHY, etc) are also available from Doctor’s Data and Great Plains Laboratory.

Additionally, if you interpret your raw genotype test through Genetic Genie, it will also provide you with an analysis of the methylation genes. Genova Diagnostics offers SNP profiles that look at five key areas of health in their Genovations line: CardioGenomic, DetoxiGenomic, EstroGenomic, ImmunoGenomic, and NeuroGenomic.

Coming back to Jill, she’s grateful in hindsight that she didn’t do any testing back in the mid-90’s. She feels as though the results could have potentially driven her a little nutty. So with all of this said, it boils down to one important question for you. How much do you really WANT to know?

Why do you get hay fever every spring, while others are totally unaffected? Why can one person cuddle up with their dog, while you break out in hives from merely petting the furry little guy? Allergies and autoimmunity are complicated conditions that exist on a spectrum, and have a few things in common.

The underlying cause of both is inflammation.

Having the right genetics predisposes you to developing them.

The epigenetic factors responsible for manifesting the symptoms are probably more important than the genes themselves, since the environmental influences on the genes are what cause them to be turned on or off.

Epigenetics are all of the environmental factors that control your genes, so if you’re stressed out, not sleeping, eating an inflammatory diet, not exercising, and are surrounded by toxins in your home and on your body, there’s a good chance you’ll have some kind of inflammatory symptoms. These could be itchy, watery eyes from allergies or fatigue, brain fog, and constipation from an autoimmune condition.

These factors cause your immune system to kick up and start overreacting to normal stimuli, which ultimately produces systemic inflammation. Identifying the symptoms can help you get to the bottom of what’s causing your autoimmunity or allergies.

Symptoms of Autoimmunity and Allergies

Autoimmune and allergy symptoms are all on the inflammatory spectrum, so they can literally affect your entire body and cause many symptoms simultaneously.

Lab testing for allergies and autoimmunity can be exhausting, since the symptoms are vast and systemic.

Allergies are more easily tested, as you can do IgE antibody testing or skin prick testing to identify environmental allergens.

If your symptoms are outside the realm of typical allergies, then further investigation is warranted. Start with general testing to confirm that you have an inflammatory or autoimmune-based condition.

The serum labs for nonspecific markers of inflammation will let you know if you have an inflammatory or autoimmune process going on inside your body. If your symptoms coincide with a specific illness—for example, stomach pain, brain fog, and depression would possibly correlate to celiac disease—then specific testing should be initiated as well.

An important feature of reversing inflammatory, allergic, and autoimmune processes is finding the root causes. GI infections, food sensitivities/intolerances, toxicity, and hormone imbalances are all causes that could be contributing to your condition, and should be identified.

Autoimmunity and Allergy Testing

Allergy tests:

IgE antibody testing

Skin prick (scratch) testing

General inflammation and Autoimmunity tests:

CRP (C-reactive protein)

ESR (erythrocyte sedimentation rate)

ANA (anti-nuclear antibody)

APA (anti-phospholipid antibodies)

RF (rheumatoid factor)

Lactoferrin

Calprotectin

Testing for specific conditions is the next logical step if general testing suggests an autoimmune or inflammatory process, or if your symptoms correlate to a specific condition. For example, TPO (thyroperoxidase antibody) and TGA (thyroglobulin antibody) should be tested for autoimmune hypothyroidism (Hashimoto’s).

Allergies are a hypersensitivity reaction to a substance that normally doesn’t cause a problem in most people. Once the substance is encountered and your immune system identifies it as foreign, it creates specific antibodies against the substance’s antigens (proteins).

IgE antibodies are one of several types of antibodies. They’re created when your body has a true allergic response to a substance and is considered a fixed allergy in that it will almost always provoke an immune response when the allergen is encountered. This type of testing analyzes your blood for the presence of IgE antibodies.

The skin prick or scratch test is often used as a quick screen, as it can be completed during an office visit. This test is administered on your back or arm, and anywhere between 20 to 40 substances can be tested, from dust, dander, and pollen to mold and foods.

A drop of the allergen is placed on your skin, and then a lancet is used to prick the skin, allowing the allergen to penetrate. Fifteen minutes later the results will be interpreted. A positive reaction will form a raised red bump that may itch (called a wheal). This type of test is usually performed in your doctor’s office.

General Inflammation and Autoimmunity Tests

CRP (C-reactive protein) is a protein made largely in the liver, immune, and fat cells in response to various inflammatory processes, such as tissue damage, infection, and disease states.

It’s released into the blood within a few hours of the inflammatory event; thus, it’s called an acute phase reactant. It’s a general marker of inflammation and isn’t specific to any particular condition. It can be used to track inflammatory and autoimmune conditions, as well as monitor flares. It’s often ordered with an ESR.

ESR (erythrocyte sedimentation rate) describes the inflammatory process in which red blood cells (erythrocytes) clump or aggregate together, causing sedimentation. The ESR measures the rate at which the erythrocytes settle in one hour in a vertical tube. It’s useful for assessing tissue destruction and levels of inflammation. Similar to CRP, the ESR is also a non-specific marker.

ANA (anti-nuclear antibody) is measured to assess levels of antibodies produced against the nucleus of a cell. It can be useful for identifying autoimmune conditions that affect multiple tissues throughout the body, such as lupus (SLE). ANA is a general indicator and isn’t specific to one particular condition.

APA (anti-phospholipid antibodies) reflect antibody production against phospholipids, which are required for blood clotting. APA is useful in blood clotting disorders, some of which are autoimmune, and for diagnosing lupus.

RF (rheumatoid factor) is an antibody that’s detectable in up to 80% of rheumatoid arthritis (RA) cases, but it can also be present in other autoimmune conditions such as lupus, scleroderma, and Sjogren’s. It can be helpful in distinguishing RA from other arthritic disorders.

Lactoferrin is a protein produced to combat inflammation. Lactoferrin can be measured in a stool sample and reflects inflammatory processes. It’s useful in diagnosing ulcerative colitis (UC) and Crohn’s versus non-inflammatory IBS. Since it isn’t specific, other causes of inflammation must be investigated such as dysbiosis, GI infection, and food intolerance.

Calprotectin is another protein measured in the stool that’s produced by a white blood cell called a neutrophil. Since neutrophils aggregate at the site of inflammation, calprotectin is more useful for diagnosing UC and Crohn’s against non-inflammatory IBS, as well as monitoring their progression. Other sources of inflammation should still be ruled out with other tests.

Testing for Specific Conditions

These are some of the common antibody (Ab) and gene tests associated with specific conditions. They may be helpful in diagnosis, along with other advanced tests and procedures such as biopsy or imaging.

There are also specialty lab tests for celiac that involve testing IgG and IgA antibodies against gliadin, glutenins, gluteomorphins (made during the digestion of gliadin), and tissue transglutaminase. Cyrex Laboratories offers this panel, which is called the Array 3: Wheat/Gluten Proteome Reactivity & Autoimmunity.

Cyrex also offers the Array 5: Multiple Autoimmune Reactivity screen that measures IgG and IgA antibodies against 24 tissues and organs in the body. It includes many of the specific antibody tests, including ASCA, ANCA, TPO, TGA, GAD 65, and APA (discussed previously).

This test is very useful because it screens most of your body at once for AI, and when you have one known autoimmune condition, there’s an increased risk for autoimmune activity against other tissues. The tests in this panel can also be obtained in smaller panels according to condition or tissue type, including diabetes, neurological, and joint autoimmune reactivity screens.

Most of these tests can be obtained and completed by going through Direct Labs, which is a centralized location to buy and organize tests from labs such as LabCorp or Quest, as well as specialty lab companies who do mold and inhalant allergy testing.

To tell you that sugar is bad for you would be beating a horse that’s long been dead. We all get it by now. But what exactly does it do that’s so bad?

For starters, it’s a major source of inflammation, tissue destruction, brain degeneration, cardiovascular disease and depression.

Elevated blood sugar literally causes damage everywhere in the body and impacts other hormones, compounding this effect. What’s even worse is that it sets the stage for metabolic syndrome, diabetes and cardiovascular disease.

Low blood sugar doesn’t get as much press, since it doesn’t cause as much damage, but the downstream effects on other hormones are no less important.

Getting your blood sugar and metabolic hormones (such as insulin and cortisol) back in check is essential for reversing inflammation, aging, and many disease processes. Since blood sugar regulation reflects many disorders of metabolism, understanding the symptoms is the first step.

Testing for blood sugar and metabolic hormone imbalance is more straightforward than other types of testing.

The goal is to find out if your blood glucose levels—and the hormones related to blood sugar management and metabolism—are functioning properly.

This can be determined with an initial set of tests that assess blood sugar levels and management, as well as hormone regulation. After initial testing is completed, additional testing may be warranted. If you find that you have elevated blood sugar with poor blood sugar management, evaluating inflammation, lipids, and cardiovascular markers is an important secondary step.

Fasting glucose (FBG) is the initial test completed when screening for blood sugar abnormalities and diabetes. It measures the levels of glucose in the blood after a period of fasting for at least 8 hours. FBG tells you if your blood sugar is high or low and can reflect metabolic imbalance. Blood glucose levels are largely dependent on 3 factors:

The ability of the pancreas to produce appropriate amounts of insulin, as well the cells having the appropriate response and sensitivity to insulin.

The liver’s storage and breakdown of glycogen (the storage form of glucose in muscles and the liver to be used later as energy).

Adrenal hormone function (cortisol, epinephrine), which also impacts control of blood sugar levels.

Fasting glucose can also be measured daily at home with a glucometer.

A 2-hour glucose tolerance test (GTT) is done to assess how efficiently your body responds to glucose. This test requires an initial fasting blood draw followed by consumption of a 75 mg glucose drink. Two hours later, a second sample is drawn.

Normally, after you consume sugar, your body detects your high blood sugar, which causes the pancreas to release insulin so the sugar can be cleared from your blood and stored. The second measurement should be normal. If you have impaired glucose tolerance or insulin resistance, the blood sugar level will remain high.

Hemoglobin A1c (HbA1c) measures glycated hemoglobin, or glycohemoglobin, in the bloodstream. Glycohemoglobin is formed when circulating glucose combines with the hemoglobin in your red blood cells (RBCs).

RBCs have a lifespan of 120 days, so the amount of glycated (also called glycosylated) hemoglobin is directly proportional to the amount of glucose present in the bloodstream during that period of time.

The process of glycation is irreversible, so the greater the concentration of glucose in the blood, the more it will attach to the RBCs. HbA1c is used to monitor long-term glucose control and assist with the management of high blood sugar.

Fructosamine, similar to HbA1c, forms when glucose binds to serum proteins. Fructosamine levels represent the total amount of glycated protein in the blood. This is an irreversible glycosylation process reflecting the average lifespan of serum proteins—about 14 to 21 days. It’s used to monitor blood sugar control, but it’s less common than HbA1c.

Insulin Testing

Insulin is the hormone secreted by the pancreas in response to glucose in the bloodstream that facilitates the transport of sugars into your cells.

Fasting insulin levels are measured after a minimum of 8 hours without food to detect insulin resistance, as well as high or low blood sugar.

If the pancreas doesn’t produce adequate insulin or the body loses its sensitivity to insulin (insulin resistance), blood sugar will be elevated, while fasting insulin will be low because of the lack of insulin production and high with insulin resistance.

C-peptide levels reflect how much insulin the pancreas is producing. High levels of C-peptide indicate increased insulin production, usually in response to high blood glucose levels or insulin resistance.

This test is useful for monitoring treatment of hypoglycemia and diabetes, since it only measures the body’s insulin production. It can also be helpful in distinguishing between Type I (autoimmune) and Type 2 (metabolic) diabetes, the diagnosis of insulinomas (insulin-producing tumors), and when autoantibodies are produced against insulin. Because of this, C-peptide levels can be difficult to measure.

Metabolic Hormone Testing

Adiponectin is a hormone produced by adipocytes (fat cells) that promotes proper metabolism of sugars (carbohydrates) and fats (triglycerides). It also influences the body’s response to insulin.

Leptin is largely produced by fat cells and works in a feedback loop with the brain to regulate appetite and satiety. When sufficient amounts of food are consumed, leptin signals to the hypothalamus, telling the body it’s no longer hungry. Low leptin should signal hunger, and high leptin should signal satiety. The level of leptin you have directly reflects your total body fat.

Leptin deficiency isn’t common, but leptin resistance, much like insulin resistance, definitely is. It reflects the body’s decreased sensitivity to the hormone, resulting in increased production. Even though there are adequate amounts of leptin, hunger is still present since the signal isn’t getting to the brain efficiently.

Cortisol is a hormone produced by the adrenal glands that literally impacts the entire body by decreasing inflammation, regulating the stress response and circadian rhythms, and controlling blood sugar.

If blood sugar is high, cortisol stimulates the storage of sugar in the liver as glycogen. If you have cortisol dysregulation (adrenal fatigue or excess cortisol), your normal regulatory functions don’t occur properly, resulting in blood sugar dysregulation.

Cortisol follows a natural rhythm, peaking in the morning and falling throughout the day. Measuring this curve is best achieved through a salivary or dried urine cortisol test with four measurements.

Metabolic Inflammatory Testing

Homocysteine is an amino acid produced as an intermediate product in the metabolism of the amino acids methionine and cysteine (the process is called methylation).

If methylation doesn’t occur properly due to a lack of key nutrients like B12, B6, and folic acid, or because of a genetic mutation (MTHFR), homocysteine levels can rise in the blood.

Elevated homocysteine is associated with an increased risk of Alzheimer’s, cardiovascular disease, and stroke, since it directly damages the lining of the blood vessels. People with poor blood sugar regulation and diabetes are at an increased risk for elevated homocysteine.

C-reactive protein (CRP) or high sensitivity CRP (hsCRP) is an acute phase reactant protein produced mostly in the liver in response to inflammation. Elevated CRP is highly associated with metabolic syndrome, diabetes, high blood pressure, and cardiovascular disease, as they share the common root cause of inflammation.

Apolipoprotein B (ApoB) is a protein involved in fat metabolism and is a component of low density lipoproteins (LDL), also known as “bad” cholesterol. Elevated levels are associated with insulin resistance, high cholesterol, atherosclerosis, and heart disease.

ApoB100 is an even more specific marker, as only one molecule of ApoB100 attaches to each LDL particle, allowing for the total number of lipoproteins in circulation to be quantified. ApoB100 is a better marker of cardiovascular risk than LDL.

Lipoprotein a(Lp(a)) consists of an LDL particle bound to the protein apoA. Levels of Lp(a) have a significant genetic component, and levels remain relatively constant over your lifetime. Elevated Lp(a) is a risk factor for cardiovascular disease.

Lipid Testing

Lipid testing determines whether or not a person’s cholesterol-carrying proteins are healthy or not. The standard lipid panel that measures LDL (low density lipoprotein), HDL (high density lipoprotein), and triglycerides measures total serum lipid numbers only. It can be a good general marker of cardiovascular disease (CVD) risk, especially when viewed with other biomarkers such ApoB and Lp(a).

Elevated levels of LDL and triglycerides, especially when taken in the context of other biomarkers, are associated with an increased risk of CVD, as is low HDL. This test is available through LabCorp and Quest and in expanded profiles from Spectracell, Genova Diagnostics, and Doctor’s Data.

Lipoparticle protein testing provides a more accurate assessment of your cholesterol and cardiovascular risk, as it measures the particle numbers and density. When considering each lipoprotein, size does matter. For example, LDL particles can be small, medium, or large, and the amount of cholesterol within the particles varies widely. Smaller particles are more predictive of cardiovascular disease and plaque buildup, since they can penetrate the arterial walls where the larger particles can’t.

Remnant lipoproteins (RLP) and intermediate density lipoproteins (IDL) are also associated with increased CVD risk. Large, buoyant HDL (HDL2) corresponds to a decreased risk of CVD. LabCorp and Quest offer this and call it VAP testing. Spectracell calls it Lipoparticle Protein Testing, and Genova has the CV Health Profile.

All testing that we’ve discussed can be done through Direct Labs, who has contracts with the traditional and newer labs. If you’re experiencing any of the symptoms mentioned earlier in this article, it could be worthwhile to get some simple testing done so you can know where you stand and make corresponding changes, if and where necessary.

If you’re experiencing a variety of health symptoms and have no known food allergies or sensitivities, you might wonder why you’d need to test yourself for them. You may believe that simply cleaning up your diet and eliminating soda, baked goods, sugar, and processed foods is enough. And while that’s certainly a good start, it’s not nearly enough to eliminate the immune and inflammatory processes that food reactions can cause.

Since eating is such an automatic process for most of us, we never stop to consider whether the symptoms we’re experiencing are related to food unless the reaction occurs while we’re actually eating or very soon thereafter.

If you have brain fog, fatigue, congestion, rashes, joint pain, or headaches, there’s a pretty good chance that your body is reacting to something you’re eating.

For many people, food is the most inflammatory substance they encounter on a daily basis. Because we eat multiple times a day, and because we’re creatures of habit, we tend to consume the same things, giving the immune system the opportunity to react.

Food sensitivities and allergies cause many symptoms, especially if you have a leaky gut. Any symptoms of inflammation or autoimmunity can point to food intolerances, so the list is vast.

Symptoms of Food Allergies and Sensitivities

The symptoms of food intolerance can manifest quickly, as with a swollen tongue or anaphylaxis, but quite often the symptoms are delayed. This makes them hard to pick up on, as well as attribute to a certain food.

The first method of screening isn’t a lab test at all. It’s an elimination diet. Eliminating the most common sources of food intolerances is a great way to find out if you have an issue.

Removing gluten, dairy, corn, soy, eggs, and nuts from your diet for 4 weeks, then adding them back one single food (not food group) at a time over a period of 3 days should tell you whether your body is reacting to something.

If you have a known autoimmune condition, you may also want to include the nightshade vegetables, such as tomatoes, potatoes, sweet and hot peppers, eggplant, and spices made from these, as well as gluten cross-reactive foods like coffee, chocolate, and the gluten-free grains.

If any of the previously mentioned symptoms appear during that 72-hour window, you should avoid that food for at least 6 months to give your immune system a break and let the inflammation go down.

This method can you help you to identify the source of your food troubles, but for some, reactions can occur to even the healthiest foods, such as blueberries or spinach, especially if they have a leaky gut. To further complicate matters, not only do the foods themselves cause a response, but the additives, colorings and gum resins (binders used in gluten-free foods) do as well. This is where testing can be valuable.

Food Allergies vs Food Sensitivities

Food allergies and sensitivities are very different issues. A food allergy occurs when the immune system identifies a food as a foreign substance and attacks it. This response occurs on a spectrum and can be anything from a swollen tongue to anaphylaxis, which is a potentially life-threatening reaction.

Food allergies are tested by measuring antibodies in the blood against particular foods. IgE and IgG are commonly measured. If you have an obvious response to a food, you can confirm it with this type of testing.

Food sensitivities are the more common and elusive form of food intolerance. They’re more vague than allergies and are considered to be any toxic or inflammatory response to food. Quite often they’re mediated by a lack of enzymes, stomach acid, and/or a leaky gut. Celiac disease is a perfect example, where a severe intolerance to gluten causes the destruction of the surface of the small intestine.

Testing for food sensitivities offers a variety of options; antibody and mediator release testing (MRT) are two of the better ones available. No matter what test you choose, be aware that if you have a leaky gut, there’s a good chance you’ll be reacting to many of the foods you eat.

Food Allergy and Sensitivity Tests

There are several types of testing available for identifying food allergies and sensitivities. IgE testing represents the true food allergy test. IgG testing can also identify allergies, but more commonly, it shows delayed sensitivity reactions. The rest of the testing options are for intolerances or sensitivities only.

IgE antibody test

IgG and IgA antibody test

Gluten and gluten cross-reactivity tests

MRT test

IgE Antibody Testing for Food Allergies

Antibodies are produced when your body mounts an immune attack on a substance it has identified as foreign, which in this case is food. It creates antibodies against specific proteins (antigens) in that food. Antibody tests measure your body’s immune response to a particular substance or organism.

There are several categories of antibodies. IgE antibodies are created when your body has a true allergic response to a substance, which is why traditional food allergy testing analyzes antibody levels in the blood. An IgE allergy is considered a fixed allergy in that it will almost always provoke an immune response when the food is consumed. This type of food allergy elicits an immediate response.

This test can be completed by traditional labs such as LabCorp or Quest, as well as the specialty lab companies Alletess Medical Laboratory and Great Plains Laboratory. IgE testing can easily be ordered online through Direct Labs.

IgG and IgA Antibody Testing for Food Allergies and Sensitivities

In spite of having an allergy, you can still yield a negative IgE test result. This is why it’s important to test IgG levels as well. IgG antibodies measure a delayed hypersensitivity reaction, which can take up to 72 hours to occur. These are the more difficult reactions to link to a particular food, so testing can be helpful here. IgG antibodies are the most prevalent antibodies in systemic circulation and are the most common form of immune-mediated food responses.

While some IgG responses represent true allergies, most are hypersensitivities or intolerances. Similarly, IgA antibodies also represent delayed hypersensitivities. They can take many hours or days to occur and operate in a low-and-slow manner.

All of these IgG and IgA tests can be ordered online through Direct Labs.

Gluten and Gluten Cross-Reactivity Tests

If you suspect that you’re sensitive to gluten, or even have full-blown celiac disease, testing is an important piece of the puzzle. Gluten testing involves analyzing the IgG and IgA response to various components of the gluten molecule, including several gliadins, glutenins, gluteomorphins (made during the digestion of gliadin), and the intestinal enzyme transglutaminase. It’s important to note that you must consume gluten for this test to be as accurate as possible.

Once you confirm gluten intolerance or celiac disease, completing gluten cross-reactivity testing is helpful, since these foods elicit the same response from the immune system as gluten does. This means that they contain similar protein sequences as the gluten molecule (molecular mimicry). Milk, whey, chocolate, coffee, soy, potatoes, corn, eggs, and most gluten-free grains (including rice) are considered cross-reactive.

The MRT utilizes different technology than antibody testing. It quantifies the inflammatory response to specific foods and additives. Mediator release refers to the inflammatory chemicals that are liberated from your cells in response to a sensitizing food.

Instead of measuring antibody production, this test measures your white blood cells’ chemical response to a food. It gauges the cells’ change in volume, which comes from the release of inflammatory chemicals such as histamine and cytokines. A non-reactive food will produce no change, while a reactive food will produce an increase or decrease in cell volume.

This is a blood test and is only offered by Oxford BioMedical Technologies.

The Bottom Line on Food Allergy and Sensitivity Tests

Start with the basics and conduct an elimination diet. That alone will give you new information to work with. From there, spend money only on the testing that could reveal new information that would alter your approach to food. If you’re already 100% gluten-free and are avoiding all cross-reactive foods as well, then gluten testing would be a waste of time and money.

So be smart and be proactive. Discovering hidden food allergies or sensitivities could make a huge difference in your day to day health.

Most of us have felt that special feeling. You know the one. Great night out with friends, maybe even a special someone. And then the next morning rolls around. THAT feeling.

You wake up to a pounding head, nausea, aches, brain fog and an inability to focus. That’s your liver screaming at you.

Those extra few drinks just needed to happen, huh?

So those are obvious signs that we recognize easily, but did you know that when your hormones are out of whack, your blood sugar is erratic, and you constantly feel sluggish, your liver is STILL speaking to you?

Most of us are great at listening to our bodies when we experience something as uncomfortable and excruciating as a bad hangover, but we’re more likely to ignore the signs when they’re less obvious or when they require lifestyle changes that we may not want to make.

The liver is the largest internal organ and has extraordinary resiliency, as it’s bombarded daily with an onslaught of assaults from air pollution, environmental toxins, medications, and microorganisms (bacteria, mold, fungi, and viruses).

It’s clear that it takes a lot to knock the liver down, but somehow, in our crazy, high-stress lives, we find a way to do just that.

Impaired detoxification and liver function is the predecessor of many systemic diseases, including liver disease. At least 30 million people, or 1 in 10 Americans, has some type of liver disease.1

If you consider some of the other conditions where liver function is important, including autoimmunity, cancer, cardiovascular disease, diabetes, and high cholesterol, it’s obvious that proper liver function and detoxification are central to health. So it’s important that we recognize the signs of impaired detoxification before it has the chance to become a full-blown condition, because reversing it is much easier than reversing most chronic diseases.

What Exactly is Liver Detoxification?

Detoxification is the process of transforming and removing harmful substances from the body. Normally, the liver takes a toxic substance, then neutralizes and transforms it so that it can be eliminated in a healthy way that doesn’t damage the body.

Once your liver detoxifies and breaks down a substance, it’s excreted to the blood or bile for elimination. Blood products are filtered through the kidneys and eliminated as urine, while bile products are sent to the intestines and eliminated as feces. Some items are also eliminated through sweat and breathing.

When detoxification doesn’t occur efficiently and properly, the liver becomes taxed and sluggish, which impacts almost every system of the body in some way. The liver plays a role (to varying degrees) in most biological functions, being responsible for over 200 tasks. Here is a short list of some other liver functions that detoxification impacts:2,3

Conversion of harmful ammonia to urea

Clearance of bilirubin (if there’s a buildup of bilirubin, the skin and eyes turn yellow in a condition called jaundice)

Storage of essential vitamins and minerals, and conversion to their biologically active forms

Regulation of amino acid and protein metabolism

Maintenance of hormone balance

Impaired detox results in changes to all of the above processes, which can manifest as imbalanced hormones, high cholesterol, blood sugar abnormalities, decreased immune function, increased inflammation and pain, and a variety of symptoms ranging from fatigue and brain fog to rashes and headaches.

How Does Liver Detoxification Become Impaired?

Impaired liver detoxification occurs when any substance or disease process compromises the liver’s ability to perform its basic metabolic functions.

When your liver can’t function properly, toxins and metabolic waste back up and accumulate in your body, making you feel horrible and causing damage to your cells.

A good way to imagine this is to think about it like taking out the trash. If you empty the waste bins throughout your house daily, even every couple of days, you’re probably in good shape.

But what if you let it pile up for a month, or even a year? Pretty soon you’re looking like you belong on a late-night cable TV show because your house is teeming with bacteria, mold, parasites, and volatile chemicals, soon to be deemed uninhabitable by the health department. When your liver can’t empty the trash on a continual basis, this is what happens inside your body.

Damage to your liver cells can occur through a variety of mechanisms:3

Metabolic disorders such as obesity, diabetes, and fatty liver

A high sugar and carbohydrate diet or processed foods

Illnesses that produce toxins and inflammation or promote malabsorption

Infections such as Candida, viral hepatitis, and any GI infection/dysbiosis

What all of these processes have in common is that they damage liver cells in some form, whether from oxidative stress, inflammation, or a lack of the nutrients the liver needs in order to work properly. The damage results in impaired detoxification systems.

Detoxification processes in the liver are controlled by many genes and the Phase 1, 2, and 3 detoxification pathways. In order for detoxification to occur properly, the genes that control the process need the correct nutrients and environment (epigenetics) to properly regulate the enzymes that control the detoxification pathways.

One group of genes that have received publicity lately are the methylation pathway genes (MTHFR, MTRR, CBS, COMT, etc.), and rightfully so. This group of genes plays a central role in detoxification, as well as neurotransmitter, hormone, and amino acid metabolism, cardiovascular health, DNA synthesis, and gene regulation.

Sometimes there are changes in a gene—SNPs, or single nucleotide polymorphisms—that alter the function of the corresponding enzyme that controls a process such as detoxification.

When you have an SNP, it changes the gene’s instruction manual, which alters the way the enzymes work.

For instance, if you have one copy of an MTHFR (methylene tetrahydrofolate reductase enzyme) gene SNP, you’ll have a 30% reduction in the activity of the enzyme. If you have 2 copies of the SNP, you’ll have a 70% reduction in enzyme activity and significantly impaired detoxification. Many people have multiple SNPs in this pathway, resulting in reduced detoxification capacity.

Similarly, the 60 cytochrome P450 (CYP450) family of enzymes that are primarily found in the liver play a significant role in the breakdown of toxins. SNPs affect the CYP450 enzymes as well—especially those involving drug metabolism.

“Depending on the gene and the polymorphism, drugs and supplements can be metabolized quickly or slowly. If a cytochrome P450 enzyme metabolizes a drug slowly, the drug stays active longer and less is needed to get the desired effect. A drug that’s quickly metabolized is broken down sooner, and a higher dose might be necessary to be effective. Cytochrome P450 enzymes account for 70 to 80 percent of enzymes involved in drug metabolism.”5

The Phase I detoxification system is controlled by these CYP450 enzymes and is the first step toxins go through in the breakdown process. Once toxins enter this pathway, the substance undergoes a chemical transformation, producing an intermediate that’s often as toxic or more toxic than the original substance.

This isn’t a big problem if your Phase 2 detoxification pathways are sufficient, but there can be SNPs here too, reducing the process’ efficiency and causing you systemic problems.

Phase 2 detoxification reactions involve the conjugation (coupling) of the Phase 1 intermediate to a substance, making it water-soluble and suitable for elimination via urine and bile (feces).

Essentially, what’s happening in all of these processes is that the intermediate is combined with a specific type of molecule that neutralizes it for elimination. For example, in methylation, a methyl group (CH3) is transferred to the intermediate. Once this process takes place, the neutralized substance can be eliminated.

Phase 3 of detoxification takes the neutralized substance and transports it out of the liver cell to be excreted in the urine or bile.

Diet, nutritional status, illness, toxic burden, dysbiosis, and SNPs all affect the efficiency of the detox pathways, and vice versa. Identifying any potential roadblocks and cleaning up your personal environment and/or lifestyle is necessary to have detoxification systems running at peak performance.

Triggers of Impaired Liver Detoxification

We have toxins around and inside us that come in many forms. If we don’t have healthy detox processes, they accumulate and cause damage all over our bodies. Common triggers of impaired liver detoxification are:

Dietary triggers of impaired liver detoxification are many and significant, since you eat multiple times every day. This provides lots of opportunities to ingest something harmful.

High sugar and carbohydrate diet: When you eat excessive sugar and carbohydrates or refined foods, they need to be stored somewhere if you aren’t using them for energy. They end up stored in the body as fat and in the liver as glycogen.

Over time, if this process continues, the liver becomes inundated with fat, which compromises its function and promotes inflammation and insulin resistance, according to Dr. Mark Hyman.6

Processed foods: Any foods that come from a package may contain trans fats, preservatives, colorings, dyes, additives, and artificial sweeteners that are seen as toxins by your body. Additionally, some foods you think are safe may not be. Most cans are lined with BPA, rendering the foods inside very unhealthy.

Xenoestrogens: Xenoestrogens are substances that mimic the hormone estrogen. Foods and chemicals are sources of these compounds. Not only are they endocrine disruptors, but also toxins and carcinogens. Soy is the most common dietary source. Consumption of soy is linked to infertility, thyroid disruption, and breast and prostate cancers. Toxins produced in the processing of soy include nitrosamines, lysinoalanine, MSG, and aluminum.7

Water: Water can be one of the most toxic things we consume daily. Water can have microorganisms, chlorine, fluoride, agricultural and manufacturing runoff, pesticides, or heavy metals. Dr. Deanna Minish states, “Current estimates suggest that there are more than 2,000 toxins in tap water.”14 Bottled water is often not much better.

GMOs: Genetically modified foods contain genes that aren’t native to the original organism, and your body sees them as foreign and toxic. Corn, for instance, might contain Bt toxin or Roundup Ready genes so that it withstands pests better. These toxins degrade the stomach of the target insects and are now found to be harming humans, causing allergies and immune system activation similar to that of inflammatory conditions.8

Further, the pesticide Roundup (glyphosate) has been proven to have harmful mechanisms. According to Dr. Mercola, a recent study found that “glyphosate inhibits cytochrome P450 (CYP) enzymes, a large and diverse group of enzymes that catalyze the oxidation of organic substances.” This, the authors state, is “an overlooked component of its toxicity to mammals (which means humans).

By limiting the ability of these enzymes to detoxify foreign chemical compounds, glyphosate enhances the damaging effects of those chemicals and environmental toxins you may be exposed to.”9

Conventional meat and produce: Food grown or raised with conventional methods (non-organic) has some level of toxicity. Meat, poultry, and fish can be given antibiotics and drugs that affect their growth.

Vegetables and fruit can contain pesticides or be genetically engineered. One potent class, the organophosphates, are linked to infertility and impaired growth and development, and they’re known neurotoxins.

Nutrients: In order for detoxification to proceed the right way, it requires adequate amounts of the necessary raw materials to do so. These include amino acids, B vitamins, minerals, antioxidants, and sulfur-containing compounds. Deficiencies will result in impaired detox processes.

Dysbiosis

Dysbiosis occurs when there’s an imbalance between the beneficial and harmful organisms in your body, especially in the gut.

When this happens, the bad guys can produce toxins themselves or even undo all of the work the liver has done (deconjugation), allowing toxins back into circulation. While many organisms produce toxins (bacteria, mold, yeast, and parasites), here are some examples:

Candida: Yeast ferments sugars into ethanol and acetaldehyde, which are carcinogens that cause alcohol toxicity and hangovers. Candida increases levels of ammonia, which is another toxin.3 Yeast also produces toxins that allow them to bore into the intestinal wall, as some parasites and bacteria do.12

Clostridium difficile: Also known as C. diff, this bacteria produces several toxins that act on the gut and other cells of the body. These toxins are responsible for the awful diarrhea associated with an acute C. diff infection.

Mold: Molds are ubiquitous and often ingested in air and food. According to Dr. Jill Carnahan, “Some molds secrete mycotoxins. Exposure to mold and mold components is well known to trigger inflammation, allergies and asthma, oxidative stress, immune dysfunction, and neurological damage in humans.”13

Leaky Gut

Increased intestinal permeability, also known as leaky gut, occurs when the cells that line the intestinal tract become irritated and compromised, actually spreading apart and allowing particles that wouldn’t normally enter the bloodstream to pass through. This causes the immune system to react to these substances, producing inflammation.

Some of the irritants that cause leaky gut are toxins ingested in medications, alcohol, food, and water, as well as the byproducts of any allergic or sensitivity reaction. Further, dysbiosis and any gut infections compound this effect by the contribution of the toxins they produce.

When you have a leaky gut, your overall toxic burden is increased, because many more substances enter circulation than usual, and your liver has to detoxify all of them. This can place a significantly increased burden on the liver.

Toxins

Toxins are everywhere in our modern society. Unfortunately, our exposure to medications, supplements, chemicals, pesticides, pollutants, petrochemicals, heavy metals, tobacco smoke, and even alcohol are byproducts of contemporary living, and most of us have exceeded our liver’s natural capacity to cleanse us. If we can’t rid ourselves of these toxins, they accumulate and are stored in the body.

Heavy metals are everywhere—in the soil, in our homes and food, and as byproducts of industries, car exhaust, and tobacco smoke, so they’re hard to avoid. Things like lead, mercury, arsenic, cadmium, and aluminum are damaging toxins by themselves, but they also compromise our detoxification pathways, making matters worse.

Over 80,000 POPs have been released into the environment, and we lack information on how they affect human health. We know they’re particularly toxic, causing infertility and endocrine hormone disruption as well as being immunotoxic, neurotoxic, and carcinogenic.16 They’re also linked to cardiovascular disease, obesity, and diabetes.16

Even medications and supplements can have adverse effects on detoxification by damaging the liver. Certain prescription and over-the-counter drugs list liver damage as a side effect and a risk. Some of these include antidepressants, antipsychotics, corticosteroids, non-steroidal anti-inflammatory medications (NSAIDs) (particularly acetaminophen (Tylenol)), and others.3 Some herbal supplements are implicated here as well since they can be toxic to the liver if not used appropriately, such as kava kava, skullcap, and germander.

Stress

Not only do we have toxins that come from the outside, but we also generate them from within. Psychological stress, toxic relationships, illness, and anything else that disrupts your body’s natural balance produces biochemical changes that impair detoxification. But to fully understand toxicity, you must understand the concept of total load.

Dr. Mark Hyman explains this idea well. “This is a total amount of stressors on your system at any one time, and what happens is like a glass filling over with water. It takes a certain amount to fill the glass, and then, after a certain point, you put more in and it overflows. When our detoxification system is overwhelmed, is overloaded, that’s when we start getting symptoms and get sick, but it may take years of accumulated stress and toxins to get to that point.”18

He further points out that stress is a significant contributor to the total toxic load, including “the mental, emotional, and spiritual toxins that affect us; isolation, loneliness, anger, jealousy, and hostility, which all translate into toxins in our system.”18

Dr. Deanna Minich elaborates on that concept, stating, “When we don’t properly ‘eliminate’ unhealthy emotions, we may experience increased levels of stress. Stress not only causes inflammation, but can elicit poor digestive function. Those who experience chronic stress have a difficult time maintaining a positive outlook on life and are at greater risk for disease and premature death.”17

Chronic stressors cause an imbalance between the sympathetic (fight or flight) and parasympathetic (rest and digest) nervous systems, producing increased levels of the stress hormone cortisol. Over time, the constant cortisol elevation and demand leads to cortisol resistance and diminished cortisol.

Cortisol is the main anti-inflammatory hormone in your body, and when levels are low, inflammation increases. This results in oxidative stress and free radical damage. This in and of itself can damage the liver, but it also increases the toxic load the liver must clean up. Further, these changes can also perpetuate dysbiosis and leaky gut.

Symptoms of Impaired Liver Detoxification

The symptoms of impaired liver detoxification are system-wide in the body.

Liver function and organic acid testing is important so you know the state of your liver and detoxification pathways. When considering toxin testing, you need to be cautious, because some of the tests actually liberate toxins from storage in your cells, which can cause problems, especially if you have a leaky gut.

In general, it’s a good idea to make sure liver function has improved and the gut is healthy before testing and treating toxins.

General tests for liver function and blood sugar:

Total bilirubin

AST (aspartate aminotransferase)

ALT (alanine aminotransferase)

GGT (gamma glutamyl transpeptidase)

ALP (alkaline phosphatase)

Fasting insulin and glucose

CMP or comprehensive metabolic panel (will have most of the liver tests on it)

Supporting healthy and robust detoxification takes a little effort. Cleaning up your diet,environment, and lifestyle and adding in some supporting nutrients will lighten the load on your liver.

Detoxifying your diet is a good place to start, since we consume foods and liquids many times every single day.

Drink lots of water every day! Have at least eight glasses to flush your system. Add some liver for an added boost.

Eating organic and GMO-free will help you avoid many toxins.

Make sure your diet is rich in phytonutrients. Certain plants are known to support detoxification. The Brassica family, which includes broccoli, cabbage, cauliflower, and kale, contains the sulfuric compounds sulforaphane and indoles (I3C) that activate the Nrf2 gene, which increases many of the detoxification enzymes, especially in Phase 2.10,11,20 Garlic also has sulfur compounds that exert the same effect. Other Nrf2 activators include curcumin from turmeric, capsaicin from hot peppers, and resveratrol from grape skin or wine.11,20

Many leafy green herbs and plants support detoxification, including dandelion greens, cilantro, parsley, watercress, and chard. Use them in cooking, salads, smoothies, and juices.11,19

Artichoke, asparagus, and beets are healing to the liver with antioxidants that prevent liver damage. Artichoke is also one of the best stimulators of bile flow.11,19

Be sure to wash your produce well—even if it’s organic.

Cook with lower temperatures to avoid generating harmful chemicals. If you must grill, marinating with olive oil, lemon, and herbs such as rosemary, thyme, and oregano will help decrease the amount of HCAs and PAHs formed.

Avoid packaged foods as much as possible, including drinks in plastic bottles.

Invest in a water filter that filters out chlorine, fluoride, metals, and microbes. Most sink-mounted and pitcher systems don’t do this.

In addition to detox-supporting foods, there are nutrients obtained in supplements that directly support the liver and detoxification process.

Amino acids: This is one of the most critical nutrient groups, as these acids function in the detoxification process itself and serve as antioxidants.

N-acetylcysteine (NAC) is the precursor to glutathione, the master antioxidant of the body and a significant component of Phase 2 detoxification.

Cysteine and methionine contain sulfur and contribute to the sulfation pathways. Methionine is also a methyl donor to the methylation pathway in its activated form, S-adenosyl-methionine (SAMe). Glycine also performs conjugation down the glycination pathway.10,20

Glutathione: Taking glutathione itself as a supplement or through IV therapy is helpful when levels need to be increased.

B vitamins: The B complex vitamins, especially B5, B6, B12, and folic acid are significant co-factors in the Phase 1 and 2 detoxification reactions that help drive the reactions forward. The methylation pathway is also very dependent on sufficient levels of B12 and folic acid.

Minerals: Iron, magnesium, zinc, and selenium are all minerals that support the detoxification process as co-factors or through antioxidant functions.20

Antioxidants: Antioxidants such as alpha lipoic acid (ALA), vitamins A, C, and E, and flavonoids play an important role, since the detox process inherently produces free radicals that need to be quenched.10,11,20

Milk thistle: Silymarin is the polyphenol in milk thistle that promotes detoxification. The antioxidant capacity of silymarin can lower the liver’s oxidative stress associated with toxin metabolism, which has the effect of conserving cellular glutathione levels.11

Calcium-D-Glucarate: This nutrient helps prevent the deconjugation of toxins in the intestines by bacteria, thus preserving them for excretion.

Probiotics: Probiotics will help maintain the balance between good and bad bacteria in the gut, which supports healthy elimination and immune functions that in turn support the liver.

Diet and nutrients can support the detoxification process itself, but the other half of the equation involves cleaning up your world.

Lifestyle changes involve some work, since they require you to read labels, investigate your personal environment, and make some changes, but the benefits to your health are worth it.

Start reading labels: The more you know about what you put in, on, and around your body, the better. If you can’t pronounce it, you should probably avoid it. Knowledge allows you to make healthier choices for you and your family.

Clean up your products: Choose more natural personal care products, toiletries, baby products, home cleaners (especially window and bathroom cleaners), and lawn fertilizers. These products are laden with preservatives and chemicals. Baking soda, coconut oil, white vinegar, lemon, and essential oils can fill many of these roles without the unwanted toxins.

Detox your furniture and home: Furniture, paint, flooring (especially carpet), and building materials also contain chemicals that give off gas, meaning they constantly emit these toxic compounds into the air and you breath them in. Opt for more natural materials like bamboo, latex, wool, and organic cotton.

Get some houseplants: Many houseplants such as English ivy, rubber plants, peace lily, golden pothos, spider plants, Boston ferns, queen ferns, and dwarf date palms are all great at filtering toxins from the air.

Air filters: Having HEPA filtration added to your heating and cooling system will result in more toxins and fine particulates being removed from your home air.

Open your windows: Indoor air can be more toxic than outdoor air, so open your windows and let your home and office breathe.

Shower filter: Invest in a shower water filter or a whole house unit. Your skin is the largest organ in your body (and the liver is the largest organ inside) with a high capacity for absorption. It will absorb toxins in the water you bathe in.

De-stress: Lower your stress levels by finding ways to either decrease your stressors and create boundaries or find appropriate outlets like talking, journaling, or exercising. Getting out into nature can be especially helpful.

Toxic relationships: If you have a person in your life who’s causing you to feel bad, hurt, angry, or frustrated, you should let them know if you can. If you can’t, then try to limit contact with them.

Sleep: Getting 8-9 hours of sleep per night is important, since this is when your body regenerates and heals.

Sauna: Sweating is also a critical component of detoxification. You can do it through exercise or using a sauna. Saunas increase circulation and metabolic rate. Studies show that many metals, especially cadmium and nickel, are eliminated through sweat at higher levels than through urine.15

Bowel movements: Make sure you have 1-2 bowel movements per day. Daily elimination through the bowels, urine, and sweat are vital for proper detoxification.

Most micronutrients, such as vitamins, minerals, amino acids, and fatty acids, don’t get much notoriety (except for vitamin D and omega-3 fatty acids), but they should. These nutrients are the building blocks of every single process in your body, and without them, disease and dysfunction ensue.

Scurvy is a great example. Lack of vitamin C in the diet of British sailors during the 18th century caused bleeding gums and mucous membranes, poor wound healing, and spots on the skin. If left untreated, they would die from blood loss.

Vitamin C is essential for the formation of collagen in hair, skin, and nails, blood clotting, nerve and muscle function, and is an important co-factor in many biochemical reactions.

We take for granted that getting the correct balance of nutrients is required for maintaining good health. Even a small deficiency in one nutrient can have major consequences in the long run. Conditions ranging from acne to heart disease start with some type of nutrient deficiency or excess.

The symptoms are seemingly limitless, since almost every symptom has a nutrient component. So understanding the important ones is crucial to good health.

When considering the possibility of nutrient imbalances, people often start by assessing symptoms and trying to guess which individual nutrients might be associated with them. This is a less efficient way to do things, as you might miss important nutrients.

For instance, if you have neuropathy or tingling in your legs, you might look at vitamins B6 or B12, since they’re important for nerve function. But if the underlying cause is high blood sugar, you’d also want to know your magnesium, zinc, chromium, inositol, carnitine, lipoic acid, biotin, and vitamin B3, C, D, and E levels as well to have a more complete picture and treatment plan.

Since symptoms of nutrient deficiency and excess are vast, starting with a test that looks at many nutrients in an expansive panel is often a better way to go. The panels available now allow you to check multiple nutrients simultaneously, giving you greater knowledge of your body and the ability to rebalance nutrient levels properly.

Balancing nutrients appropriately is crucial, since too much of one and not enough of another can cause further trouble.

Nutrient Tests

There are many different types of test panels you could choose for analyzing your nutrient status. Depending upon your symptoms, condition, and health goals, you may want to select a smaller panel.

Or, if you’re unsure, a more expansive panel that looks at everything is a good choice.

Nutrient Panels:

Organic acid testing

Amino acid testing

Fatty acid testing

Combination nutrient testing

Organic Acid Testing

Organic acids (OA) are the end products (metabolites) generated by your metabolic processes,and they are easy to measure in urine. Organic acid testing provides an indirect way of measuring nutrient status, since all of your metabolic processes require certain vitamins, minerals, amino acids, and other micronutrients to function properly. It you are deficient in specific nutrients, it will show up as increased or decreased metabolites in the urine.

Nutrient deficiencies have several effects on metabolic reactions. First, serious deficits will impede biochemical reactions from occurring at all, giving a result that is below test detection limits.

Deficiencies can also cause a reaction to be limited/inefficient—producing low levels of metabolites—or cause a backup (think log jam) because there isn’t enough nutrient cofactor to propel the reaction forward. This results in an excess level of metabolites in urine.

Dysbiosis markers indicate the need for glycine, glutamine, and an amino acid complex.

Organic acids testing is available from Genova Diagnostics and Great Plains Laboratory.

Amino Acid Testing

Amino acids are the building blocks of proteins. When you eat protein, your body breaks it down into usable units, or amino acids, that are vital to life.

Non-essential amino acids can be made in your body, but some must be obtained through the diet. These are called essential amino acids. As individual amino acids, or linked as chains called peptides, they have many functions:

Amino acids can be assessed in the urine or blood. Genova Diagnostics, Doctor’s Data, and Great Plains Laboratory offer amino acid testing.

Fatty Acid Testing

Fatty acids are the technical term for what we typically think of as “fat.” For example, fish oil is comprised of the omega-3 fatty acids EPA and DHA. Like amino acids, fatty acids can be essential or nonessential, and they play a critical role in sustaining life.

Having the proper balance of omega-3, 6, and 9 (polyunsaturated, monounsaturated, and saturated fats) is critical for maintaining health. Among other things, fatty acids:

Several companies offer comprehensive test panels that allow you to see nutrients, amino acids, fatty acids, and organic acids in different combinations, depending upon your needs.

Great Plains Laboratories can provide many different panels based on your condition or health goals. Basic and comprehensive panels for autism, ADD/ADHD, fibromyalgia, Tourette’s, mental health, and wellness options are available.